we already know that health care has big problems with continuity and coordination. The question is how the Swedish healthcare live up to the wishes of the patient and the law’s requirements today, writes Heidi Stone Myren. Photo: Janerik Henriksson / TT
the Swedish medical Association has long pushed the requirement of a permanent contact for health care. A responsible doctor stands for continuity, security and guarantee of equal treatment and increased patient safety. Not least towards patients with less ability to meet their care needs.
The requirement for the attention of a physician has strong popular support. In February 2016 the Medical Association asked (by Sifo) a cross-section of the population: How important is it to have a named doctor with overall responsibility for the possible treatment of recurrent contacts with health care? Half (50 percent) stated that it is very important to have a named doctor. Another 28 percent reported a 4 on the 5-point scale of importance. This means that a total of 8 out of 10 Swedes believe that it is important to a fixed contact with a physician. Particularly important is the medical continuity for women over 65, more than 80 percent believe it is very important to have a named doctor with overall responsibility.
1991 introduced patient, the physician in charge (PAL) in health care law to promote continuity and patient related to a responsible physician. PAL was removed from the Act in 2010 and was replaced by “permanent health care contact” with responsibility for coordination. This care contact shall be appointed by the operations manager if it is necessary for the safety of patients, or if the patient wants it. Thus arose a threshold for the patient to have a designated contact and it does not need to be someone who is medically responsible. Only in life-threatening condition, the host connector to be a doctor, according to the National Board of Health regulations.
When the permanent health care contact was introduced, it was not the legislature’s intent to impair patients’ ability to obtain an unnamed physician in charge. On the contrary, the operations an obligation to appoint a doctor to patients who need or want it.
We already know that health care has big problems with continuity and coordination. The question is how the Swedish healthcare live up to the wishes of the patient and the law’s requirements today.
The Medical Association has in a recent survey study examined how patient the legal regulation of the health care contact affected doctors’ ability to provide medical continuity. The survey shows that the introduction of the health care law provision of permanent health care contact even in the Patient Act has not affected health care practices or doctors’ ability to provide medical continuity. The provision of permanent health care contact is still relatively unknown and operational procedures for the appointment of permanent health care contact is largely lacking. Follow-up of medical continuity is rare.
Only 40 percent of respondents doctors feel they have good or very good conditions to offer medical continuity. A large majority also experiencing shortages in the position to coordinate the efforts between medical care units. The control and compensation, as well as IT support is considered in exceptional cases, supporting an approach that involves medical continuity and coordination of patient. A lack of staffing and a business organization that does not allow medical continuity of absence for vacation or illness is perceived as obstacles.
We have, in other words a law that is not followed, which of course is unacceptable.
A key conclusion from the study is that the conditions for medical continuity can be influenced. Doctors whose activities are actively working to provide medical continuity are more satisfied, both with the staffing and how the business is organized to cover up the absence. This shows that the local implementation of the health care contact is very important for the intentions of the legislation is to be realized. A majority of respondents doctors consider a patient to the physician in charge (PAL) would strengthen medical continuity considerably.
The Medical Association conclusion of the study is that measures must be taken at different levels.
• The state must tighten both regulatory and monitoring. In today’s fragmented care with soda, different cost centers and organizational barriers, a clear governance to strengthen the whole surrounding the patient. We suggest that the government gives the Board was tasked to follow up the implementation of permanent health care contact and evaluate whether patients need PAL really get it. The follow-up should form the basis for the authority to consider further regulation. The National Board should, in consultation with the profession, regulating the right to PAL as permanent health care contact in the regulation for patients with unmet health care needs. Inspectorate for Health Care must also strengthen supervision of the caregivers live up to the health care legislation continuity requirements.
• The conditions in health care need to be tightened. Medical Continuity requires that healthcare IT systems can communicate with each other across organizational boundaries. The control and compensation systems must become more general, reward continuity and build on the trust in the professional responsibility, to facilitate continuity of medical priority.
• Operations-routines for PAL must be implemented consistently. The care should develop procedures for the permanent health care contact and medical continuity that builds on the specific nature of the activity. In the design of these routines have included medical profession. The fixed contact care should be named PAL when a doctor holding function. With a patient, the physician in charge, it becomes clear to patients and health professionals as part of the duties, responsibilities and authority.
These actions require no major government inquiry, but can be introduced now. If all positive forces interact, all severely ill patients will soon be guaranteed a doctor that the health care contact and thus a safe and secure care.
Heidi Stone Myren
Chairman, Swedish medical Association
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