Master's Programme in Public Health Science

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Browsing Master's Programme in Public Health Science by Author "Hunsberger, Monica"

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    Impact of COVID-19 on the management of autoimmune disease in Sweden
    (2021-08) Staaf (previously Atkins), Emily; Hunsberger, Monica; Univeristy of Gothenburg, School of Public Health and Community Medicine, Sahlgrenska Academy, Institute of Medicine
    Objective: To determine the extent and nature of changes in healthcare resource use and deaths during the COVID-19 pandemic of patients with multiple sclerosis (MS) or rheumatoid arthritis (RA) in Sweden, with a focus on digital events and planned visits. Methods: Patients had a main diagnosis of MS or RA between 2014-2020 (“incident”) or 1987-2020 (“prevalent”). Retrospective aggregate data were obtained from the National Patient Register on patient characteristics, number of in- and outpatient events in specialised healthcare, planned visits, digital events, inpatient admissions, and length of stay for overnight admissions in each study period. From the Cause of Death Register, the number and top causes of death were obtained for patients in each study period, as well as the number with COVID-19 as an underlying cause of death. Healthcare use during the COVID-19 pandemic was observed for 7 months in 2020, and equivalent annual study periods between 2014-2019 were used to determine normal variation. Results: Compared to normal annual variation, specialised healthcare use by MS and RA incident patients did not change during 2020. However, the number of planned inpatient visits decreased, and number of digital outpatient visits significantly increased (P>0.005) for both diseases. The number of deaths was not notably different in the COVID-19 study period, although COVID-19 was found to be one of the most common causes of death in RA patients in 2020. Conclusions: This study provides evidence of MS and RA patients’ healthcare resource use in Sweden during the COVID-19 pandemic, and the results suggest that whilst the use of specialised healthcare has remained fairly unchanged, patients appear to have avoided physical visits and instead migrated towards digital visits. Further research is needed to explore the long-term effects of the pandemic on healthcare resource use in order to strengthen these conclusions.
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    Investigating relationships between sickness absence rate, level of education and immigrant status
    (2021-11-04) Culcear, Adelina Roxana; Hunsberger, Monica; Univeristy of Gothenburg, Department of Public Health and Community Medicine Sahlgrenska Academy, Institute of Medicine
    Introduction: The rate of sickness absence is one of the greatest concerns in the developed countries especially because long-term sickness absence was associated with negative impacts on individual health, increased risk for permanent disability, and exclusion from the labor market. According to previous literature, long-term sickness absence, permanent work disability, and disability pension were found to be higher among immigrants compared to natives. Aim: To investigate if the proportion of immigrants in the municipalities from Västra Götland’s Region has a relationship with the level of sickness absence and if this relation remains unchanged if immigrants’ level of education is considered. Methods: An ecological study design was adopted, using data of 2019 from Statistics Sweden (SCB) and the Swedish Social Insurance Agency (Försäkringskassan). The study is based on the Region Västra Götland from Sweden, and it includes 49 municipalities. The main group of interest is the immigrants’ group who are persons born outside Sweden and have non-Swedish parents. Simple and multiple regression models were utilized to investigate if the proportion of immigrants influences the level of sickness absence and if changes occur when considering immigrants’ level of education. Within the analyses, we controlled for some confounding factors such as sex (proportion of females), age, household size, average income, population density and proportion of divorced persons. Results: There was a statistically significant relationship between sickness absence rate and immigrant status, but there was not found a significant relationship between sickness absence and education. Thus 1 unit increase in proportion immigrants reduces by 1.4% sickness absence while education level is not considered. However, the estimated effect increased to 1.6% when we accounted for education level. Conclusion: Surprisingly, in Region Västra Götland, the high number of immigrants contributes to the decrease of the sickness absence rate. This result could be due to the sickness presenteeism or to the healthy immigrant effect. The statistically insignificant relation of the level of education on the sickness absence rate may indicate a mismatch between education and job of the immigrants, but also a lack of adjustment to the labor market and society.
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    Priority setting for acute surgery procedures
    (2022-06-21) Glantz, Hillevi; Hunsberger, Monica; Univeristy of Gothenburg, School of Public Health & Community Medicine
    Accessibility as well as providing care on equal terms to all inhabitants are the main objectives stated in the Swedish law SFS 2017: 30. As Sweden is facing demographic imbalances with more patients in need of care, prioritization decisions have become more common. Health care professionals daily face various forms of prioritization decisions on how to use available resources to provide care on equal terms. However, a literature review scoping relevant existing research shows that guidelines on how to prioritize care in daily practices are few. Further, no studies give an in-depth process description on how priority decisions might be evaluated or improved in practice. The study's extensive empirical material was obtained by observations and interviews from a four-month long improvement process at Skaraborgs Hospital Group (SkaS) that sought to improve local priority guidelines for acute surgery within as well as between specialties. The case description gives an overall narrative of a long volatile process with perspectives from both involved and non-involved staff capturing the work to improve prioritization routines at SkaS. The research questions focus on how priorities for acute surgery are currently performed at SkaS and what factors affect priority setting? Further, is the current priority setting perceived to be fair and work towards the targeted statutory objectives in practice? Finally, has the priority process affected SkaS and what benefits and shortcomings can be identified to improve priority setting in daily practice? A thematic qualitative content analysis was used to identify key themes that were related to the research questions. The identified themes were also validated by participants in the improvement project. The study´s result found homogeneous perceptions among co-workers regarding routines and justice in the case process concerning priorities, but certain scenarios imply that some priorities were not solely based on patient's needs assessment. However, patient safety and medical treatment quality were found to not be at risk despite delayed acute surgeries. Transparent dialogues with an understanding of each specialty department's patients were found to be a key factor to improve current routines. The main benefit was insights of learning in the process. In addition, routines for priorities between specialties were argued to be beneficial to continuously work with. The organization's process confirms that SkaS succeeded to decide on a value-creating change to prioritize elective surgeries according to eight principles stated in the Swedish law. The study’s findings support previous research that there remain conflicts of priority setting in healthcare, especially regarding horizontal practical priorities. The study also provides an insight into processes from everyday care illuminating how priorities are complied with in practice. The findings could be relevant for other health care organizations working with improvements project in similar contexts.