Heavy consumption of dental services; a longitudinal cohort study among Finnish adults

Peer reviewe

Use of email in communication between the Finnish primary healthcare system and general practitioners

Background The volume of emails is rising rapidly everywhere. However, there is no data available concerning how primary healthcare physicians feel about the use of email communication between themselves, with their managers and with other people contacting them. Objective The objective of this study was to find out what the attitudes of primary care physicians are towards email at work. Methods The use of email was studied among a convenience sample of primary healthcare physicians. Results Physicians thought that email was a good instrument for delivering information but not as an instrument for leadership. Physicians in lead positions thought more often than ordinary general practitioners (GPs) that email is good for information. The leaders used email more actively than other GPs. The contents of the emails received by the GPs differed depending on the site of work. The total number of emails was higher in urban areas than in rural areas. Emails relating to administration, educational information and meeting materials were more often sent in rural than in urban primary healthcare settings. Information about daily work arrangements and about social events were more frequently emailed in urban than in rural surroundings. Email was considered important for information inside the system but a somewhat difficult tool for discussing complicated subjects. Generally, it was agreed that there was some unimportant information filtering through this medium to the target GPs. GPs were uncertain whether important data reached everybody who needed it or not. Still, almost everybody used the email system regularly and the use of it was considered relatively easy. GPs were generally prone to adopt advice and instructions given via email and implemented those in their working routines. The use of the email system was related to technical ability to use the system. The easier the GP thought that the email system was the more he used it. Rural GPs were more critical in applying advice shared via email than their counterparts in urban areas. In general, physicians thought that email was a good method for reaching many people at the same time. However, the main points of the messages may be missed and the whole email may sometimes not be read. Conclusion Especially during periods of change in the workplace, it is very important that management is conducted personally. Care must be taken so that disinformation does not spoil the informative value of email in the administration of primary health care. The needed technical assistance should be given to everyone in order to get the best advantage from the use of the email system

Cluster analysis identifies unmet healthcare needs among patients with rheumatoid arthritis

Objective: To identify the patterns of healthcare resource utilization and unmet needs of persistent disease activity, pain, and physical disability in rheumatoid arthritis (RA) by cluster analysis. Method: Patients attending the Jyvaskyla Central Hospital rheumatology unit, Finland, were, from 2007, prospectively enrolled in a clinical database. We identified all RA patients in 2010-2014 and combined their individual-level data with well-recorded administrative data on all public healthcare contacts in fiscal year 2014. We ran agglomerative hierarchical clustering (Ward's method), with 28-joint Disease Activity Score with three variables, Health Assessment Questionnaire index, pain (visual analogue scale 0-100), and total annual health service-related direct costs (euro) as clustering variables. Results: Complete-case analysis of 939 patients derived four clusters. Cluster C1 (remission and low costs, 550 patients) comprised relatively young patients with low costs, low disease activity, and minimal disability. C2 (chronic pain, disability, and fatigue, 269 patients) included those with the highest pain and fatigue levels, and disability was fairly common. C3 (inflammation, 97 patients) had rather high mean costs and the highest average disease activity, but lower average levels of pain and less disability than C2, highlighting the impact of effective treatment. C4 (comorbidities and high costs, 23 patients) was characterized by exceptionally high costs incurred by comorbidities. Conclusions: The majority of RA patients had favourable outcomes and low costs. However, a large group of patients was distinguished by chronic pain, disability, and fatigue not unambiguously linked to disease activity. The highest healthcare costs were linked to high disease activity or comorbidities.Peer reviewe

A comparative study of two various models of organising diabetes follow-up in public primary health care – the model influences the use of services, their quality and costs

Background In Finland diabetologists have long been concerned about the level of diabetes care as the incidence of type 1 diabetes and complicated type 2 diabetes is exceeding the capacity of specialist clinics. We compared the outcome of diabetes care in two middle-sized Finnish municipalities with different models of diabetes care organisation in public primary health care. In Kouvola the primary health care of all diabetic patients is based on general practitioners, whereas in Nurmijärvi the follow-up of type 1 and most complicated type 2 diabetic patients is assigned to a general practitioner specialised in diabetes care. Methods Our study population consisted of all adult diabetic patients living in the municipalities under review. We compared the use and costs of public diabetes care, glycemic control, blood pressure, LDL-cholesterol level, the application of the national guidelines and patient satisfaction. The main outcome measures were the costs and use of health care services due to diabetes and its complications. Results In Nurmijärvi, where diabetes care was centralised, more type 1 diabetic patients were followed up in primary health care than in Kouvola, where general practitioners need more specialist consultations. The centralisation resulted in cost savings in the diabetes care of type 1 diabetic patients. Although the quality of care was similar, type 1 diabetic patients were more satisfied with their follow-up in the centralised system. In the care of type 2 diabetic patients the centralised system required fewer specialist consultations, but the quality and costs were similar in both models. Conclusions The follow-up of most diabetic patients – including type 1 diabetes – can be organised in primary health care with the same quality as in secondary care units. The centralised primary care of type 1 diabetes is less costly and requires fewer specialist consultations.Peer reviewe

Terveyskeskuksen tuottavuuden mittaamisen edellytykset – Havaintoja pilottihankkeesta

Julkisen terveydenhuollon kustannukset muodostavat merkittävän osan valtion ja kuntien menoista. Valtion Vaikuttavuus ja tuloksellisuus –ohjelma (aiemmin Tuottavuusohjelma) pyrkii osaltaan hillitsemään kustannusten kasvua määrittämällä tuottavuuteen vaikuttavia tekijöitä ja kohdentamalla resursseja tehokkaasti (Valtiovarainministeriö, 2013). Tuotannon tehostaminen mahdollistaa suuremman tuotannon samoilla resursseilla tai saman tuotannon pienemmillä resursseilla. Terveyskeskusten tuottavuus -pilottihankkeen tavoitteena oli tarkastella mahdollisuuksia kerätä ja mitata panos- ja tuotostietoja aiempaa tarkemmin ja selvittää sen tuottamaa hyötyä tuottavuustutkimukselle. Tulos oli kolmitahoinen. Yhtäältä, tuotostietojen keruun tarkentamisen lisäksi tulisi keskittyä samassa suhteessa panostietojen yhdenmukaiseen keräämiseen ja tarkentamiseen. Pilottihankkeessa annetusta tarkan panostietojen keruun ohjeistuksesta huolimatta, tiedot olivat varsin puutteellisia ja niiden tarkkuudessa oli merkittävää vaihtelua. Toiseksi, diagnoositietojen heikko kirjaamisalttius aiheutti osaltaan sen, että tuotteistamisella ei saatu täysimääräistä hyötyä tuottavuuslaskentaan vaan tuottavuustulokset olivat yhtä luotettavia kuin potilaiden lukumääriä laskettaessa. Kolmanneksi, niissä terveyskeskuksissa, joissa diagnoosikirjaaminen oli hoidettu hyvin, tuotosmääritteen tarkentaminen panoshintavakioidussa tuottavuusvertailussa paransi terveyskeskuksen sijoitusta kuvaten siten hyvin tuotteistuksen merkitystä tuottavuusanalyyseissa.Costs of the public health care system constitute a non-negligible part of the public expenses of the Finnish state and districts. By encouraging efficient resource allocation, the Finnish government productivity program aims at higher productivity and tries to steer productivity into a direction of hindered public cost formation. Intensification of production enables more output with the same amount of inputs or the same output with less input. Primary health care productivity research pilot project concentrated on possibilities for more accurate data collection, input and output measurement, and effect of that on productivity measurement outcomes. The results were three-folded. Firstly, while the concentration has been quite often on output measurement and improving of it, at least as much concentration should be dedicated for the input measurement. The pilot revealed that regardless of uniform guidelines to provide with the input data collection there was wide variation on its accuracy. Secondly, low tendency of diagnose-recording into districts' databases made productisation almost useless, and thus the productivity results were as accurate as by using plain head count of the patients as an output measure. Thirdly, when making use of use of priceadjusted inputs (person months), in those primary health care centres where diagnose-recording tendency was high, productisation improved remarkably productivity results compared to those where the tendency was lower

Costs structure of the inpatient ischemic stroke treatment using an exact costing method

Objectives: Most stroke care expenses are in hospital costs. Given the previously reported inaccuracy of conventional costing, the purpose of this study was to provide an accurate analysis of inpatient costs of stroke care in an acute care hospital. Materials and methods: We used activity-based costing (ABC) for calculating the costs of ischemic stroke patients. We collected the activity data at the Helsinki University Central Hospital. Persons involved in patient care logged their activities on survey forms for one week. The costs of activities were calculated based on information about salaries, material prices, and other costs obtained from hospital accounting data. We calculated costs per inpatient days and episodes, analyzed cost structure, made a distinction in cost for stroke subtypes according to the Oxford and TOAST classification schemes, and compared cost per inpatient episode with the diagnoses-related group (DRG) -price of the hospital. Results: The sample comprised 196 inpatient days of 41 patients. By using the ABC, the mean and median costs of an inpatient day were 346 (sic) and 268 (sic), and of an inpatient episode 3322 (sic) and 2573 (sic), respectively. Average costs differed considerably by stroke subtype. The first inpatient day was the most expensive. Working time costs comprised 63% of the average inpatient day cost, with nursing constituting the largest proportion. The mean cost of an inpatient episode was 21% lower with ABC than with DRG pricing. Conclusion: We demonstrate that there are differences in cost estimates depending on the methods used. ABC revealed differences among patients having the same diagnosis. The cost of an episode was lower than the DRG price of the hospital. Choosing an optimal costing method is essential for both reimbursements of hospitals and health policy decision-making.Peer reviewe