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Hälso- och sjukvårdens roll som informationskälla för hälsoläget i befolkningen och uppföljning av dess folkhälsoinriktade insatser
Nordic Council of Ministers, Nordic School of Public Health NHV.
2009 (Swedish)Doctoral thesis, comprehensive summary (Other academic)Alternative title
Health care as a source of information for population health and follow up on public health interventions (English)
Abstract [sv]

Bakgrund: Information om hälsoläget och insatser för att förbättra hälsan i befolkningen kommer från direkta undersökningar t.ex. den nationella folkhälsoenkäten och indirekt från hälso- och sjukvården. Men för insamling, analys och återföring av kunskaper om ohälsan från vården liksom för vidtagna hälsofrämjande och sjukdomsförebyggande åtgärder saknas allmänt tillämpade rutiner.

Syfte: Att analysera sjukvårdens roll och metoder när det gäller information om hälsoläget i befolkningen samt stödja utvecklingen av informationssystem för analys av hälsan liksom för uppföljning av hälso- och sjukvårdens folkhälsoinsatser.

Metoder: Projektet inleddes med att informationssystemet Minimum Data Set för distriktssköterskeverksamhet (MDS-DSK) implementerades och utvärderades i Örebro läns landsting (I). Därefter analyserades patientjournaler från distriktssköterske-verksamheten genom triangulering för att identifiera och kategorisera använda åtgärder som stöd för utveckling av informationssystem (II). För att svara på frågan om patientregistrets validitet som mått på hälsoläget i en befolkning jämfördes dess data om förekomst av ischemisk hjärtsjukdom i en kommun med uppgifter insamlade från alla offentliga vårdgivare i öppen och sluten vård (III). Slutligen undersöktes genom en folkhälsoenkät i vilken omfattning hälso- och sjukvården ger rådgivning om levnadsvanor och vilka faktorer som påverkar rådgivningen (IV).

Resultat: MDS-DSK gör det möjligt att utifrån distriktssköterskeverksamhet göra uppskattningar av förekomst av hälsoproblem i befolkningen (I). Analys av distriktssköterskornas journaler visade ett brett spektrum av väl definierade åtgärder från hälsofrämjande och hälsoskyddande till diagnostiska, terapeutiska, rehabiliterande och palliativa (II). Jämförelsen av individrelaterade data om förekomst av ischemisk hjärtsjukdom och dess riskfaktorer visade att mindre än hälften av de berörda individerna identifierats i patientregistret (III). Det är rökning och fysisk aktivitet, som oftast är tema för sjukvårdspersonalens frågor och rådgivning till patienterna. Sannolikheten att bli tillfrågad minskar med stigande ålder och kvinnor tillfrågas i mindre utsträckning än män. Personer med ohälsa där levnadsvanor anses spela stor roll exempelvis personer med diabetes, fetma och högt blodtryck får rådgivning i högre utsträckning (IV).

Slutsatser: Med utvecklade informationssystem finns det goda möjligheter att samla in och analysera data från hälso- och sjukvården för att få ökade kunskaper om befolkningens hälsoläge och individrelaterade, hälsoinriktade åtgärder inom vården. Rutiner för detta saknas i stor utsträckning.

Abstract [en]

Background: Information about health in the population and interventions to improve public health can be assembled directly through the National Public Health Survey and indirectly from health care. However, there are no generally applied routines for collection, analysis, and reporting of information from health care for public health interventions. In addition there are no routines for collection and feed-back of public health measures in health care.

Aims: To analyse the role of health care and its methods of information about population health, and to support the development of health informatics and methods on follow up on public health interventions in health care.

Methods: This project started by implementation and assessment of the Minimum Data Set instrument for public health nurses (PHN-MDS) in Örebro County (I). Next, clinical notes from public health nurses were analysed by a triangulation process and core elements identified, to be used in the information model (II). The Hospital Discharge Register is often used as a proxy for disease and disability in the population. In order to test its validity, data were collected for each individual who used an official care provider in a well defined geographical area (III). The final work (IV) uses data from a Public Health Survey in order to assess how and to whom health care professionals present questions and advice on health related life style and what factors influence this.

Results: The PHN-MDS makes it possible to assess health problems in the population (I). Analyses of clinical notes from public health nurses showed a broad spectrum of interventions ranging from health promotion to diagnostic, therapeutic, rehabilitation and palliative actions (II). The comparisons of data on ischemic heart disease and its risk factors on an individual level indicated that less than half of the cases were identified in the Hospital Discharge Register (III). Smoking and physical activity are the most common themes for questions and counselling by professionals in health care. The probability to be asked decreases with age, and women are less often given questions and advice. Persons with obvious needs of counselling e.g. with diabetes, obesity and high blood pressure were more likely to receive counselling (IV).

Conclusions: Development of health informatics makes it possible to collect and analyse data from health care in order to broaden the knowledge on health in the population, as well as on individual counselling within health care. Unfortunately, routines based on developed health informatics systems are insufficient

Place, publisher, year, edition, pages
2009. , 67 p.
Series
NHV Reports and Doctor of Public Health-Theses, ISSN 0283-1961 ; NHV Report 2009:3
Keyword [en]
Informatics, public health, medical records, data collection, information storage and retrieval, health care management
Keyword [sv]
Informatik, folkhälsa, patientjournaler, datainsamling, informationslagring och –återvinning, hälso- och sjukvårdsadministration
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:norden:org:diva-3665ISBN: 978-91-85721-61-0 (print)OAI: oai:DiVA.org:norden-3665DiVA: diva2:785286
Public defence
2009-05-15, Nordic School of Public Health NHV, Göteborg, Sweden, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2015-02-03 Created: 2015-02-02 Last updated: 2015-02-03Bibliographically approved
List of papers
1. The public health nursing minimum data set: Development, application and use
Open this publication in new window or tab >>The public health nursing minimum data set: Development, application and use
2009 (English)In: OmvårdnandsforskningArticle in journal (Refereed) Published
Keyword
nursing informatics, health care mangement, pulic health nursing minimum data set, categorization of the reason for contacts, categorization of the health care services, epidmiology, utlization of public health nursing
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:norden:org:diva-3663 (URN)
Available from: 2015-02-02 Created: 2015-02-02 Last updated: 2015-02-03Bibliographically approved
2. Health promotive action and preventive action model (HPA model) for the classification of health care services in public health nursing.
Open this publication in new window or tab >>Health promotive action and preventive action model (HPA model) for the classification of health care services in public health nursing.
2002 (English)In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 30, no 3, 200-8 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: There is a need for an expanded approach to develop knowledge of public health nursing as a sphere of public health. The aim of this paper was to construct a theoretical model for healthcare services in the area of public health nursing based on the analysis and classification of healthcare services used in public health nursing practice.

METHODS: Patient records were examined using a qualitative research approach. The categorization and classification of the actions followed certain criteria. Three methods were used for verifying and modifying the concept.

RESULTS: Of the identified categories 34 dealt with healthcare services, three with administrative services, and five with coordination. The six recognized domains of the healthcare services are health promotive services, health protective services, diagnostic services, therapeutic services, rehabilitation services, and terminal healthcare services. Using the public health approach, the Health promotive action and preventive action model (HPA model) was constructed in order to visualize where in the course of the process of health-ill health and developmental stages the public health nurses provide healthcare services. Health promotion and the levels of prevention are described on the operational and conceptual levels in this paper.

CONCLUSIONS: The result is expected to have an important effect on how public health nurses conceptualize their field of knowledge. The classification reflects current public health policy by focusing on health promotion and illness prevention. The developed HPA model will support health service research.

Keyword
classification, health informatics, nursing documentation, public health nursing, public health model, theory construction
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:norden:org:diva-3661 (URN)10.1080/14034940210133834 (DOI)12227976 (PubMedID)
Available from: 2015-02-02 Created: 2015-02-02 Last updated: 2015-02-03Bibliographically approved
3. Validity and utilization of epidemiological data: A study of ischaemic heart disease and coronary risk factors in a local population
Open this publication in new window or tab >>Validity and utilization of epidemiological data: A study of ischaemic heart disease and coronary risk factors in a local population
2009 (English)In: BMC Public Health, ISSN 1471-2458, Vol. 123, no 1, 52-57 p.Article in journal (Refereed) Published
Abstract [en]

Objectives

To calculate the burden of ischaemic heart disease (IHD) and coronary risk factors in a defined population using data from all public providers of health care, i.e. inpatient and outpatient care in all settings.

Study design

Cross-sectional, 1-year retrospective study.

Methods

The main outcome measures were the number of individuals by diagnosis and by care setting, and gender- and age-specific event rates by diagnosis.

Results

Less than half of the individuals who visited any care provider for IHD or coronary risk factors were identified in the hospital discharge register. Calculation of the actual burden of disease in the population showed that when hospital discharge data were combined with outpatient data, there were no or slight differences in the age-specific rates of acute myocardial infarction (AMI), while the rates of angina were between two-fold and four-fold higher, and unspecified IHD was between three-fold and ten-fold higher in individuals aged ≥50 years compared with using hospital discharge data alone. The rates of hypertension, diabetes and lipid disorders increased in all age groups when outpatient data were added to hospital discharge data. The differences in the rates were more pronounced in women aged 50–79 years. However, the age-specific rates were higher in men except for hypertension which was higher in older women.

Conclusion

Data for epidemiological analyses of diseases are often based on hospital discharge data. This study found that hospital discharge data provide limited information on patients treated for IHD and coronary risk factors, except for AMI. These findings suggest that hospital discharge data should be combined with outpatient care data to provide a more comprehensive estimate of the burden of IHD and its risk factors.

Keyword
Health informatics; Databases; Inpatients; Outpatients; Ischaemic heart diseases; Coronary risk factors
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:norden:org:diva-3664 (URN)
Available from: 2015-02-02 Created: 2015-02-02 Last updated: 2015-02-03Bibliographically approved

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