Reablement in a small municipality, a survival analysis

Background: Reablement is a municipal service given to patients at home. The purpose of the service is to assist recovery after hospital discharges or other sudden changes in a patient’s functional level. The service is often provided by a team of nurses, physiotherapists, and occupational therapists. The purpose of this paper is to compare users of this service to users who receive traditional home care services. Outcomes to be measured are risk of long-term care and mortality. Methods: All users of health and care services in a Norwegian municipality were eligible for inclusion. Data was extracted from the local user administrative database. Users were divided in two groups: those who received reablement and those home care users who did not receive reablement service. Propensity score matching was used to match users based on age, sex, and level of functioning in activities of daily living (ADL). Survival analysis was deployed to test if the reablement users had different risk of becoming long-term care users, and whether the mortality rate differed for this group. Results: 153 reablement users were included in the study. These were matched to 153 non-reablement home care users. The groups had similar distributions of age, sex, and level of functioning when starting their service trajectories. Regressions showed that reablement users had lower risk of using long-term care services in the study period (time at risk up to 4 years), and lower mortality. However, none of these estimates were statistically significant. Conclusions: The study indicates that the reablement users in one municipality had lower use of long -term care and lower mortality when properly estimated, but numbers were too small for statistical significance to be found.publishedVersio

Budgeting in public hospital trusts: Surplus, optimism, and accuracy

Hospitals in Norway are organized as trusts, required to follow the same accounting principles as the private sector, and responsible for funding their own investments. Thus, being able to run with a surplus has been an important part of their management. We analyze hospital budgeting for the whole sector over a 9-year period, looking at the size of the budget surplus, degree of optimism bias, and degree of budget accuracy when comparing to the actual financial results. Our findings indicate that on average, health trusts budget with a relatively small surplus. We find indications for optimism bias, but also examples of pessimism bias. Large health trusts seem to have a higher degree of accuracy of the budgeted results. Trusts that fail to meet budgeted results have a lower budgeted surplus the following period. Capital intensity, an indication of need for new investments, is not associated with budget surplus, degree of optimism, or budget accuracy.acceptedVersio

Co-creating public health measures with adolescents in municipalities: municipal actors’ views on inhibitors and promoters for adolescent involvement

Aim: To explore what municipal actors consider as inhibiting and promoting adolescents’ involvement in public health measures in municipalities. Methods: A qualitative study with individual and group interviews was conducted among 15 municipal actors who were central in involving adolescents from five Norwegian municipalities participating in the National Programme for Public Health Work in Municipalities (2017–2027). In addition, participatory observation of project activities was done in two municipalities. A data-driven thematic analysis was applied to analyse data. Results: In the analysis, we developed four themes, including both inhibitors and promoters for adolescent involvement: (a) Timeframe challenges in adolescent involvement; (b) Lack of necessary knowledge and awareness among adolescents; (c) Limited competencies and resources in the project groups; and (d) Facilitators’ attitudes on and perceptions of adolescent involvement. Conclusions: This study reports factors that are important to consider when facilitating involvement processes with young people. Findings suggest that further work should be done to ensure involvement of adolescents in public health measures in municipalities, and actors involving adolescents must be provided with competence and resources to ensure such participation.publishedVersio

Obstacles of eHealth Capacity Building and Innovation Promotion Initiative in African Countries

eHealth applications and tools have the potential to improve coordination, knowledge, and information sharing between health professionals as well as continuity of care. One of the main obstacles hindering its full integration and use, particularly in the healthcare sector in developing and low and middle-income countries is the lack of qualified staff and healthcare personnel. To explore obstacles that hinder capacity and innovation promotion initiatives, a survey was conducted among BETTEReHEALTH partners. A questionnaire was used to collect quantitative data from 37 organizations. Although there are different buckets of capacity-building and innovation promotion activities going on, the findings showed very few targeting policymakers and eHealth specialists. The findings found that obstacles to capacity building and innovation promotion include lack of finance, poor infrastructure, poor leadership, and governance, and these obstacles are context or region specific. Findings from our study concur with those from previous research on the need to identify practical solutions and simple interventions to address eHealth obstacles to capacity building in developing countries. As measures to mitigate these obstacles, our study proposed the need for adequate policies, strong political commitment, the development of academic modules to be integrated into existing educational programs, and the creation of more in-country and on-site capacity-building activities. While this study contributes to the discourse on eHealth capacity-building and innovation promotion initiatives among healthcare and public health professionals, the study has a limitation as data was collected only from BETTEReHEALTH partners.publishedVersio

Trends in Socioeconomic Inequalities in Norwegian Adolescents' Mental Health from 2014 to 2018 : A Repeated Cross-Sectional Study.

Background: Adolescents’ mental health, and its consistent relationship with their socioeconomic background, is a concern that should drive education, health, and employment policies. However, information about this relationship on a national scale is limited. We explore national overall trends and investigate possible socioeconomic disparities in adolescents’ mental health, including psychological distress and symptoms of depression, anxiety, and loneliness in Norway during the period 2014–2018. Methods: The present study builds on data retrieved from five waves of the national cross-sectional Ungdata survey (2014–2018). In total 136,525 upper secondary school students (52% girls) completed the questionnaire during the study period. Trends in socioeconomic inequalities were assessed using the Slope Index of Inequality (SII) and the Relative Index of Inequality (RII). Results: The prevalence of students with moderate to high symptoms score and mean symptoms scores of psychological distress (in terms of symptoms of depression, anxiety, and loneliness) increased among girls and boys during 2014–2018, with girls showing higher rates. Our results suggest distinct, but stable, inequalities between socioeconomic groups, both in absolute and relative terms, among girls and boys during the study period. Conclusion: Rising rates of adolescents’ psychological distress, particularly among girls, may have long-term consequences for individuals involved and the society as a whole. Future studies should investigate the causes of these results. We did not find evidence of any change in inequalities in adolescents’ mental health between socioeconomic groups, suggesting current strategies are not sufficiently addressing mental health inequalities in the adolescent population and therefore a significant need for research and public health efforts.publishedVersionUnit Licence Agreemen

Hospital productivity and the Norwegian ownership reform – A Nordic comparative study

In a period where decentralisation seemed to be the prominent trend, Norway in 2002 chose to re-centralise the hospital sector. The reform had three main aims; cost control, efficiency and reduced waiting times. This study investigates whether the hospital reform has improved hospital productivity using the other four major Nordic countries as controls. Hospital productivity measures are obtained using data envelopment analysis (DEA) on a comparable dataset of 728 Nordic hospitals in the period 1999 to 2004. First a common reference frontier is established for the four countries, enveloping the technologies of each of the countries and years. Bootstrapping techniques are applied to the obtained productivity estimates to assess uncertainty and correct for bias. Second, these are regressed on a set of explanatory variables in order to separate the effect of the hospital reform from the effects of other structural, financial and organizational variables. A fixed hospital effect model is used, as random effects and OLS specifications are rejected. Robustness is examined through alternate model specifications, including stochastic frontier analysis (SFA). The SFA approach in performed using the Battese & Coelli (1995) one stage procedure where the inefficiency term is estimated as a function of the set of explanatory variables used in the second stage in the DEA approach. Results indicate that the hospital reform in Norway seems to have improved the level of productivity in the magnitude of approximately 4 % or more. While there are small or contradictory estimates of the effects of case mix and activity based financing, the length of stay is clearly negatively associated with estimated productivity. Results are robust to choice of efficiency estimation technique and various definition of when the reform effect takes place.Efficiency; productivity; DEA; SFA; hospitals

Configuring Secretarial Workflows in the Epic EHR Suite

The primary goal of large-scale electronic health record (EHR) suites is to meet the needs of a broad range of users in healthcare institutions. EHR suites are extensively configurable, which makes it possible to tailor them to diverse professional practices and users. However, while users such as physicians and nurses may have clearly defined responsibilities, clerical personnel (i.e. secretaries) conduct “in-between” or invisible work that is not as easily defined. Therefore, it may be more difficult to tailor EHR suites to their needs. Moreover, because secretaries are quite low in the hospital hierarchy, it is difficult for them to obtain satisfactory solutions. In this paper, we explore the challenges of configuring the EHR suite for secretary workflows in the Health Platform program in central Norway

Assessing Strategic Priority Factors in eHealth Policies of Four African Countries

The use of electronic health systems is rapidly spreading in low- and middle-income countries (LLMICs). Empirical evidence shows that eHealth systems can improve access, quality, and equitable healthcare delivery, especially for the poor and vulnerable. Studies suggest that a lack of systems thinking leads to inadequate technical infrastructure, lack of interoperability, streamlining of patientand health information sharing. This article assesses the BETTEReHEALTH strategic priority factors from four African countries: Ethiopia, Ghana, Malawi, and Tunisia. The primary data source was eHealth policies from the four countries. A document analysis was conducted, complemented by deductive, qualitative content analysis. The results show these countries have adopted and implemented eHealth policies. They have dedicated governing bodies that aim to strengthen the coordination of eHealth efforts. However, there is a need for more robust government support and regulation in creating a sustainable national eHealth environment.publishedVersio

Volunteering: A Tool for Social Inclusion and Promoting the Well-Being of Refugees? A Qualitative Study

Background: The Norwegian government’s increased expectations that volunteering can be used as a means of integration and the scarce research regarding refugees’ experiences with volunteering is taken as the background for this study. Our purpose is to adopt a salutogenic perspective to investigate whether and how formal volunteering contributes to developing a sense of social inclusion and well-being among refugees in Norway. Methods: Qualitative in-depth interviews were conducted with 12 volunteers with refugee backgrounds in a semi-rural district in Norway. Stepwise deductive induction was used for analysis. Results: Three themes were identified as a result of the analysis: (1) feeling safer due to increased knowledge regarding cultures, values, and systems and achieving mutual acceptance; (2) feeling more confident when communicating in Norwegian and contributing to society, and (3) feeling more connected via social relations. Conclusions: Our study indicates that participation in volunteering may contribute to social inclusion and that the participants’ resources and volunteering experiences may have a health-promotive impact under certain conditions.publishedVersio

Ikääntyneiden kuolinpaikat Suomessa ja Norjassa

Aims: This study aimed to find out how place of death varied between countries with different health and social service systems. This was done by investigating typical groups (concerning age, sex and end-of-life trajectory) of older people dying in different places in Finland and Norway. Methods: The data were derived from national registers. All those who died in Finland or Norway at the age of ⩾70 years in 2011 were included. Place of death was analysed by age, sex, end-of-life trajectory and degree of urbanisation of the municipality of residence. Two-proportion z-tests were performed to test the differences between the countries. Multinomial logistic regression analyses were performed separately for both countries to find the factors associated with place of death. Results: The data consisted of 68,433 individuals. Deaths occurred most commonly in health centres in Finland and in nursing homes in Norway. Deaths in hospital were more common in Norway than they were in Finland. In both countries, deaths in hospital were more common among younger people and men. Deaths in nursing homes were commonest among frail older people, while most of those who had a terminal illness died in health centres in Finland and in nursing homes in Norway. Conclusions: Both Finland and Norway have a relatively low share of hospital deaths among older people. Both countries have developed alternatives to end-of-life care in hospital, allowing for spending the last days or weeks of life closer to home. In Finland, health centres play a key role in end-of-life care, while in Norway nursing homes serve this role.Aims: This study aimed to find out how place of death varied between countries with different health and social service systems. This was done by investigating typical groups (concerning age, sex and end-of-life trajectory) of older people dying in different places in Finland and Norway. Methods: The data were derived from national registers. All those who died in Finland or Norway at the age of ⩾70 years in 2011 were included. Place of death was analysed by age, sex, end-of-life trajectory and degree of urbanisation of the municipality of residence. Two-proportion z-tests were performed to test the differences between the countries. Multinomial logistic regression analyses were performed separately for both countries to find the factors associated with place of death. Results: The data consisted of 68,433 individuals. Deaths occurred most commonly in health centres in Finland and in nursing homes in Norway. Deaths in hospital were more common in Norway than they were in Finland. In both countries, deaths in hospital were more common among younger people and men. Deaths in nursing homes were commonest among frail older people, while most of those who had a terminal illness died in health centres in Finland and in nursing homes in Norway. Conclusions: Both Finland and Norway have a relatively low share of hospital deaths among older people. Both countries have developed alternatives to end-of-life care in hospital, allowing for spending the last days or weeks of life closer to home. In Finland, health centres play a key role in end-of-life care, while in Norway nursing homes serve this role.Peer reviewe