Hvis behov tilgodeses systemets eller patientens? Morten Freil Direktør www.danskepatienter.dk Nordisk kongres: Sygehuse i Fremtiden, Randers 10. september 2010
Outline of the presentation Future patients Development of healthcare system patients needs and demands Recommendations
Future patients Change in disease pattern Approximately 1.7 million Danes with one or more chronic illness Lifelong Both citizen and patient Change in patient role Seeking information Knowledge of disease and treatment Increasing demands for cooperation Coordination and continuity Involvement
Life Patient pathways Patient pathways (continuity, information etc.) Inddragelse Life (physical, mental and social)
Patient experiences Satisfied with health care professionals Insufficient involvement of patients and their relatives Lack of information Lack of coherence in information Poor cooperation No continuity of staff Inddragelse
Support and care Self-care Patient perspective Individual courses Clinical quality Accessibility Coordination and continuity Litteratur, f.eks.: - Freil M, Knudsen JL. Brugerinddragelse i Sundhedsvæsenet, Ugeskr Læger, 2009. - Coulter A et al. The European patient of the future, 2003. - Schulze SB, Gut R, Freil M. Patienters indstilling til sygehusvæsenet i Øst- og Vestdanmark medinddragelse, autoritetstro og informationssøgning, UFL 2006; 3. - Innovationsrådet, Patientforum, Danske Regioner og Oxford Health Alliance. Brugernes Sundhedsvæsen.. København, 2007 - Iversen, MG, Hansen KS, Freil M et al. Do surgical patients differ in the way they prioritize aspects of hospital care? Scand J Public Health.2009; 37: 295-303 - Kroniske syges oplevelser i mødet med sundhedsvæsenet. København: Enheden for Brugerundersøgelser, 2007 - Schulze SB, Gut R, Freil M. Nydiagnosticerede leddegigtpatienters mestring af deres hverdag, Gigtforeningen og Enheden for Brugerundersøgelser, 2007
The system and the patient Patient (Needs and demands) Coordination Involvement Focus on individual needs Free choice Holistic Accessibility Larger units Less units System (Developement) Specializations More actors Standardization Focus on diagnosis
Cancer and co-morbidity Survival No co-morbidity 1995 2000 2005 Co-morbidity (3 medical diagnosis) Ledende overlæge Ulrich Fredberg Medicinsk afdeling Regionshospitalet Silkeborg Year
Citat Der skal være en helhed i tingene, du er et helt menneske og det hele hænger jo sammen.man oplever tit det der med, at når man kommer på øjenafdelingen så, selvom de er søde og dygtige og alt muligt, så er man sådan nogle kæmpe store øjne med ben på, der kommer gående ned ad gangen. Og så på diabetes, der er man en stor bugspytkirtel med ben under altså og karkirurgisk, der er du en dunkende gang kar, der kommer gående De ser ikke det hele menneske (Patient med type-ii-diabetes) Er der styr på mig? DSI 2010
Citat Så tænkte jeg, jeg skal passe på med, hvad jeg spiser, for jeg har nemlig i mange år også haft spiserørsbrok, hvor man ikke må spise noget de sidste tre timer inden, man går i seng. Men med sukkersyge skal man faktisk spise noget, lige inden man går i seng, så det var sådan lidt af en konflikt, ikke?! (Patient med spiserørsbrok og type-ii-diabetes) Kroniske syges oplevelser i mødet med sundhedsvæsenet. København: Enheden for Brugerundersøgelser, 2007
Future healthcare (1) Involvement Equal knowledge and perspectives Patient as a resource Release from the patient role
Equal perspectives Clinical Organisational / Economic Patient
Involvement Solid evidence that involvement has an effect on: Clinical quality/ Result of treatment Quality of life and patient satisfaction Efficiency Patient safety Leads to more patient-centered healthcare eg: Coulter A, Ellins J. Patient-focused interventions A review of the evidence. London: The Health Foundation, 2006. Jacobsen CB, Pedersen VH, Albeck K. Patientinddragelse mellem ideal og virkelighed - en empirisk undersøgelse af fælles beslutningstagning og dagligdagens møder mellem patient og behandler. København: Sundhedsstyrelsen, Monitorering & Medicinsk Teknologivurdering, 2008. Freil M, Knudsen JL. Brugerinddragelse i Sundhedsvæsenet. Ugeskr. Læger, 2009
Future healthcare (2) Changing healthcare system's way of thinking in silos Functions gathered around the patient Information gathered around the patient Cooperation around and with the patient
Example Contact persons at hospitals coordinator
Patient
Forskellige perspektiver
Future healthcare (3) Communication Technology to support communications across sectors and institutions Patients participation in journal Tele-health
Future hospitals
Future healthcare Unchanged healthcare system Designed for short termed patient pathways Changed disease pattern - Lifestyle-related and lifelong diseases - Across specialties - Across sectors
Relation between hospital and patient Today The patient's body is available for the hospital The patient is passive (bedridden) Patients waiting for examinations, treatment and information In the future The hospital is available for the patient Active and involved citizen Increased self care and self-monitoring Hospital monitors (remote based) and supports
Structure and culture Current structure and culture creates solutions that are focused on institutional and sector interests Performance and quality that the institution must provide Involvement of patient interests will create solutions that focus on consistency, quality and accessibility Service and quality that the patient should receive