Enabling patient-physician continuity in Swedish primary care: the importance of a named GP. A registry-based observational study.

Background: Continuity of care is important for patients with chronic conditions. Assigning patients to a named GP may increase continuity.

Aim: To examine whether patients who were registered with a named GP at the onset of their first chronic disease had higher continuity of care at subsequent visits than patients who were only registered at a practice.

Sweden: Health System Review.

The Health Systems in Transition (‎HiT)‎ country reports provide an analytical description of each health system and of reform initiatives in progress or under development. They aim to provide relevant comparative information to support policy-makers and analysts in the development of health systems and reforms in the countries of the WHO European Region and beyond. The HiTs are building blocks that can be used: to learn in detail about different approaches to the financing, organization and delivery of health services; to describe accurately the process, content and implementation of health reform programmes; to highlight common challenges and areas that require more in-depth analysis; and to provide a tool for the dissemination of information on health systems and the exchange of experiences of reform strategies between policy-makers and analysts in countries of the WHO European Region.

Access to automated comparative feedback reports in primary care - a study of intensity of use and relationship with clinical performance among Swedish primary care practices.

Background: Digital applications that automatically extract information from electronic medical records and provide comparative visualizations of the data in the form of quality indicators to primary care practices may facilitate local quality improvement (QI). A necessary condition for such QI to work is that practices actively access the data. The purpose of this study was to explore the use of an application that visualizes quality indicators in Swedish primary care, developed by a profession-led QI initiative ("Primärvårdskvalitet").

Better with GPs as managers? - Variation in perceptions of feedback messages, goal-clarity and performance across manager´s in Swedish primary care.

Background: Primary care in several countries is developing towards team-based and multi-professional care, requiring leadership and management capabilities at the primary care practice level. This article reports findings from a study of primary care managers in Sweden, focusing variation in performance and perceptions of feedback messages and goal-clarity, depending on managers' professional background.

Methods: The study was designed as a cross-sectional analysis of primary care practice managers' perceptions combined with registered data on patient-reported performance.

The impact of audit and feedback to support change behaviour in healthcare organisations - a cross-sectional qualitative study of primary care centre managers.

Background: This article addresses the role of audit and feedback (A&F) to support change behaviour and quality improvement work in healthcare organisations. It contributes to the sparse literature on primary care centre (PCC) managers´ views on A&F practices, taking into account the broad scope of primary care. The purpose was to explore if and how different types of A&F support change behaviour by influencing different forms of motivation and learning, and what contextual facilitators and barriers enable or obstruct change behaviour in primary care.

Conditions and barriers for quality improvement work: a qualitative study of how professionals and health centre managers experience audit and feedback practices in Swedish primary care.

Background: High quality primary care is expected to be the basis of many health care systems. Expectations on primary care are rising as societies age and the burden of chronic disease grows. To stimulate adherence to guidelines and quality improvement, audit and feedback to professionals is often used, but the effects vary.

Weak association between socioeconomic Care Need Index and primary care visits per registered patient in three Swedish regions.

Objective: The objective was to examine the association between primary care consultations and a Care Need Index (CNI) used to compensate Swedish primary care practices for the extra workload associated with patients with low socioeconomic status.

Design: Observational study combining graphical analysis with linear regressions of cross-sectional administrative practice-level data.

Setting: Three Swedish regions, Västra Götaland, Skåne and Östergötland (3.

Revisiting out-of-pocket requirements: trends in spending, financial access barriers, and policy in ten high-income countries.

Background: Countries rely on out-of-pocket (OOP) spending to different degrees and employ varying techniques. The article examines trends in OOP spending in ten high-income countries since 2000, and analyzes their relationship to self-assessed barriers to accessing health care services. The countries are Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States.

Development of voluntary private health insurance in Nordic countries - An exploratory study on country-specific contextual factors.

The Nordic countries are healthcare systems with tax-based financing and ambitions for universal access to comprehensive services. This implies that distribution of healthcare resources should be based on individual needs, not on the ability to pay. Despite this ideological orientation, significant expansion in voluntary private health insurance (VPHI) contracts has occurred in recent decades.

Does risk-adjusted payment influence primary care providers' decision on where to set up practices?

Background: Providing equal access to health care is an important objective in most health care systems. It is especially pertinent in systems like the Swedish primary care market, where private providers are free to establish themselves in any part of the country. To improve equity in access to care, 15 out 21 county councils in Sweden have implemented risk-adjusted capitation based on the Care Need Index, which increases capitation to primary care centers with a large share of patients with unfavorable socioeconomic and demographic characteristics.

Process measures or patient reported experience measures (PREMs) for comparing performance across providers? A study of measures related to access and continuity in Swedish primary care.

Unlabelled: Aim To study (a) the covariation between patient reported experience measures (PREMs) and registered process measures of access and continuity when ranking providers in a primary care setting, and (b) whether registered process measures or PREMs provided more or less information about potential linkages between levels of access and continuity and explaining variables.

Background: Access and continuity are important objectives in primary care. They can be measured through registered process measures or PREMs.

Pay for performance associated with increased volume of medication reviews but not with less inappropriate use of medications among the elderly - an observational study.

Objective: A pay for performance programme was introduced in 2009 by a Swedish county with 1.6 million inhabitants. A process measure with payment linked to coding for medication reviews among the elderly was adopted.

Can pay-for-performance to primary care providers stimulate appropriate use of antibiotics?

Antibiotic resistance is a major threat to public health worldwide. As the healthcare sector's use of antibiotics is an important contributor to the development of resistance, it is crucial that physicians only prescribe antibiotics when needed and that they choose narrow-spectrum antibiotics, which act on fewer bacteria types, when possible. Inappropriate use of antibiotics is nonetheless widespread, not least for respiratory tract infections (RTI), a common reason for antibiotics prescriptions.

Does increased standardisation in health care mean less responsiveness towards individual patients' expectations? A register-based study in Swedish primary care.

Objective: We explore whether standardisation in health care based on evidence on group level and a public health perspective is in conflict with responsiveness towards individual patient's expectations in Swedish primary care.

Methods: Using regression analysis, we study the association between patient views about providers' responsiveness and indicators reflecting provider's adherence to evidence-based guidelines, controlled for characteristics related to providers, including patient mix and degree of competition facing providers. Data were taken from two Swedish regions in years 2012 and 2013.

A randomized comparison between league tables and funnel plots to inform health care decision-making.

Objective: Comparison of provider performance is commonly used to inform health care decision-making. Little attention has been paid to how data presentations influence decisions. This study analyzes differences in suggested actions by decision-makers informed by league tables or funnel plots.

The addition of S100B to guidelines for management of mild head injury is potentially cost saving.

Background: Mild traumatic brain injury (TBI) is associated with substantial costs due to over-triage of patients to computed tomography (CT) scanning, despite validated decision rules. Serum biomarker S100B has shown promise for safely omitting CT scans but the economic impact from clinical use has never been reported. In 2007, S100B was adapted into the existing Scandinavian management guidelines in Halmstad, Sweden, in an attempt to reduce CT scans and save costs.

Public reporting on quality, waiting times and patient experience in 11 high-income countries.

This article maps current approaches to public reporting on waiting times, patient experience and aggregate measures of quality and safety in 11 high-income countries (Australia, Canada, England, France, Germany, Netherlands, New Zealand, Norway, Sweden, Switzerland and the United States). Using a questionnaire-based survey of key national informants, we found that the data most commonly made available to the public are on waiting times for hospital treatment, being reported for major hospitals in seven countries. Information on patient experience at hospital level is also made available in many countries, but it is not generally available in respect of primary care services.

Short-term effects of a pay-for-performance programme for diabetes in a primary care setting: an observational study.

Objective: A pay-for-performance (P4P) programme for primary care was introduced in 2011 by a Swedish county (with 1.6 million inhabitants). Effects on register entry practice and comparability of data for patients with diabetes mellitus were assessed.

The use of outcome and process indicators to incentivize integrated care for frail older people: a case study of primary care services in Sweden.

Background: A number of reforms have been implemented in Swedish health care to support integrated care for frail older people and to reduce utilization of hospital care by this group. Outcomes and process indicators have been used in pay-for-performance (P4P) schemes by both national and local governments to support developments.

Objective: To analyse limitations in the use of outcome and process indicators to incentivize integrated care for elderly patients with significant health care needs in the context of primary care.

Changes in health care utilisation following a reform involving choice and privatisation in Swedish primary care: a five-year follow-up of GP-visits.

Background: The organisation of Swedish primary health care has changed following introduction of free choice of provider for the population in combination with freedom of establishment for private primary care providers. Our aim was to investigate changes in individual health care utilisation following choice and privatisation in Swedish primary care from an equity perspective, in subgroups defined by age, gender and family income.

Methods: The study is based on register data years 2007-2011 from the Skåne Regional Council (population 1.

Prospective study of pain, quality of life and the economic impact of open inguinal hernia repair.

Background: There are variations in quality of life (QoL) and reported risk of chronic pain after inguinal hernia repair. The aim of this study was to investigate the improvement in pain and QoL after open inguinal hernia repair, and the economic impact.

Methods: Patients undergoing open mesh repair of a primary unilateral inguinal hernia were stratified depending on preoperative levels of symptoms and pain.

Sweden health system review.

Life expectancy in Sweden is high and the country performs well in comparisons related to disease-oriented indicators of health service outcomes and quality of care. The Swedish health system is committed to ensuring the health of all citizens and abides by the principles of human dignity, need and solidarity, and cost-effectiveness. The state is responsible for overall health policy, while the funding and provision of services lies largely with the county councils and regions.