Lars Borgquist

Test characteristics of the Hopkins Symptom Check List-25 (HSCL-25) in Sweden, using the Present State Examination (PSE-9) as a caseness criterion.

SummaryThe Hopkins Symptom Check List-25 (HSCL-25) is a screening instrument designed to identify common psychiatric symptoms. It has been widely used in different settings outside Sweden and also compared to assessments of psychiatric illness made by general practitioners. The aim of the present study was to validate the HSCL-25 against a psychiatric interview using the Present State Examination (PSE-9) in a Swedish sample of patients in general practice. Validity coefficients of the HSCL-25 were calculated for two different thresholds of caseness, ≥1.55 and ≥1/75, respectively. When ≥1.75 was chosen as a cutoff point, the validity coefficients obtained by the HSCL-25 in this study were comparable to those obtained in other studies.

Willingness to pay for antihypertensive therapy -- results of a Swedish pilot study

In this methodological study the results of a Swedish pilot study about willingness to pay for antihypertensive therapy are presented. The aim of the study was to test the feasibility of the contingent valuation (CV) method in this area. Open-ended and discrete CV questions were compared in a mail questionnaire. The open-ended CV question did not work well. The answers to the discrete question, analysed by logistic regression analysis, indicated a willingness to pay in the range SEK 2500-5000 per year for antihypertensive therapy. Further studies should be undertaken to explore the reliability and the validity of the CV method.

Costs of hip fracture: Rehabilitation of 180 patients in primary health care

Costs related to functional status were calculated for 180 consecutive hip fracture patients (mean age 78 years) who were admitted from their own home and rehabilitated in primary health care. Within 4 months after the fracture, 75 percent of the patients had been discharged to their own home, 9 percent were dead, and the short-term medical treatment costs per patient were SEK 43,000, whereas the total costs including communal help and costs for living accommodations after discharge were twice as high. The total costs per patient for long-term medical treatment (from 4 months up to 3 years after fracture) were 7 percent of the short-term medical treatment costs. Patients with a cervical fracture discharged to their own home and with good functional status consumed only one fifth of the resources that patients with a trochanteric fracture discharged to institutional care and who had reduced functional status consumed. A substantial part of the costs can be saved by improved organization of rehabilitation after discharge from the hospital. A further cost reduction would require a combination of technologic, social, and organizational changes aimed at early discharge and continued follow-up in primary health care.

The Costs of Treating Hypertension in Sweden An Empirical Investigation in Primary Health Care

The treatment costs of hypertension in Sweden were calculated both at the individual and at the national level after an empirical investigation in primary health care. The average drug cost per patient and year was calculated as c. SEK 1220, the annual consultation cost as c. SEK 620, and the annual travel and time cost as c. SEK 230. About 500,000 people are treated pharmacologically for hypertension in Sweden, and about 25,000 non-pharmacologically. The total annual treatment cost for these patients was calculated as c. SEK 1100 million. The drug cost accounts for c. SEK 650 million, the consultation cost for c. SEK 330 million, and the travel and time cost for c. SEK 120 million. The drug reimbursement scheme pays almost half these costs, while the county councils and the patients pay approximately a quarter each.

FUNCTION AND SOCIAL STATUS 10 YEARS AFTER HIP FRACTURE : PROSPECTIVE FOLLOW-UP OF 103 PATIENTS

Function and social outcome for 103 consecutive patients, mean age 75 years, admitted from their own homes after a hip fracture were studied during a 10-year period. Within 4 months after the fracture, 81 patients had returned home, and the percentage of survivors living at home from then on was then fairly constant. At 10 years after fracture, 31 patients were living at home, 6 were in institutions, and 66 were dead. ADL, walking ability, and household activities remained at the level already achieved within 4 months after fracture during the 10-year period. The need for social services help did not increase; about one third of the survivors had communal home help throughout the 10-year period. Patients who before fracture were healthy and living with someone and within 2 weeks after the fracture could walk with a four-legged aid or better had a good prognosis for living in their own home. The hip fracture did not effect their subsequent fate.

Cost‐benefit analysis of non‐pharmacological treatment of hypertension

Abstract. In this study a non‐pharmacological treatment (NPT) programme and conventional drug treatment of hypertension was compared in a cost‐benefit analysis. The NPT programme involved 400 patients and was conducted at 8 health centres during the period 1984–1986. It consisted of monthly visits by a nurse, visits by a doctor every 6 months, home blood pressure (BP) measurements, dietary advice, relaxation, physical activity, etc. The patients were also followed up for 2 years after the study to assess whether the programme still worked, and whether future treatment costs were affected. The treatment costs were about SEK 5300 higher per patient for the NPT programme. The benefits, in the form of reduced treatment costs for the period 1986–1988 and willingness to pay (WTP) for the NPT programme, were about SEK 3200. Thus the NPT programme resulted in a loss of about SEK 2100 per patient. However, a longer follow‐up period is needed for any specific conclusions to be drawn about the costs and benefits of the NPT programme, as compared with conventional drug treatment.

Willingness to pay for lipid lowering: a health production function approach

This Paper reports the results of an experiment of measuring willingness to pay (WTP) for lipid lowering. WTP is derived from a theoretical model of health risk reductions, using a health production function approach. A survey of about 700 persons randomized into a lipid lowering trial in Sweden is used to estimate WTP. The willingness to give up time (WTGT) to take part in a lipid lowering programme is also measured in the survey, to assess its relationship to WTP. The response rates on the WTP and WTGT qusetions are 94% and 96%, respectively, and the patients are on average perpared to pay about Skr 350 per month or devote about 5 h of leisure time per week to get normal lipid levels. The Correlation of WTP and WTGT is 0.45 and highly significant. The results of regression of WTP and WTGT are in accordance with the theoretical predictions with a higher valuation for a greater perceived difference in health status with and without treatment. The income elasticity is also positive as expected.

Hip Fractures in Primary Health Care: Evaluation of a rehabilitation programme

The routine follow-up of hip fracture patients was transferred from the Orthopaedic Department, Lund University Hospital, to the primary health care districts in 1985. The medical state and social functions of all 298 patients during the first 12 months of the follow-up rehabilitation programme were registered. Before fracture, 61% lived in their own homes, 22% in old peoples homes, and 14% in geriatric hospitals or nursing homes. Four months after fracture, 13% were dead, 47% were living in their own homes, 14% were in old peoples homes, 25% in geriatric hospitals or nursing homes, while the rest were in other types of institutional residence. Of patients coming from their own homes, 75% were back at home four months after fracture and their social and functional status were as good as before fracture. The study has shown that routine check-ups at the orthopaedic department can be omitted. Follow-up in primary health care without radiography and orthopaedic expertise gives equally good functional results as in previous studies, provided that patients with pain and walking problems from the hip are guaranteed rapid specialist treatment.

Outcome after Hip Fracture in Different Health Care Districts: Rehabilitation of 837 consecutive patients in primary care 1986–88

The social and functional outcome for 837 consecutive hip fracture patients rehabilitated in primary care was studied during 1986-1988. Of patients coming from their own home (59%) the majority (76%) were back at home four months after fracture and had a good functional status, while 9% were dead. Predictors of managing ADL (dressing/personal hygiene) four months after hip fracture were age, type of fracture, sex, and having regular social contacts outside the home before fracture. Health care districts differed in the incidence of hip fractures, the patients hospital stay, housing, type of fracture, and age. These differences had consequences on costs. Total costs per patient were lowest in districts where most of the patients were discharged to their own homes. No significant differences in fracture incidence were seen between rural and urban primary health care districts.

Patterns of Care in Patients Utilizing both Primary Health Care and Psychiatric Care in a Swedish Health District

Patterns of care in all patients (N = 546) establishing contact with both primary health care and psychiatric care were studied during 1984 (N = 252) and 1986 (N = 294) in a Swedish health district. Utilization of primary health care was not affected by the sectorization of the psychiatric care organization, while there was a significant increase in utilization of outpatient psychiatric care. Patients with a higher number of visits in outpatient psychiatric care had a lower number of visits in primary health care. The utilization of care was unevenly distributed in the sample; 25% of the patients accounted for almost 60% of the visits in both care organizations. The mental health problems were identified in primary health care in 40% of the patients. This group of patients seemed to be defined as belonging neither to specialized psychiatric care nor to the general practitioner level of primary health care.