[EQ] Priority setting in primary health care - dilemmas and opportunities

Priority setting in primary health care - dilemmas and opportunities:
a focus group study

Eva Arvidsson 1, 2*, Malin André 3,4, Lars Borgquist 4, Per Carlsson 5

1 Department of Medicine and Health Sciences, Centre for Medical Technology Assessment, Linköping University, Linköping, Sweden

2 Department of Primary Health Care, Kalmar, Sweden

3 Centre for Clinical Research, Falun, Sweden

4 Department of Medicine and Health Sciences, Division of General Practice, Linköping University, Linköping, Sweden

5 Department of Medicine and Health Sciences, Centre for Priority Setting in Health Care

BMC Family Practice 2010, 11:71doi:10.1186/1471-2296-11-71 - September 2010

Available online PDF [31p.] at: http://bit.ly/cbtZlr

Background

Swedish health care authorities use three key criteria to produce national guidelines for local priority setting:
- severity of the health condition,
- expected patient benefit, and
- cost-effectiveness of medical intervention.

Priority setting in primary health care (PHC) has significant implications for health costs and outcomes in the health care system. Nevertheless, these guidelines have been implemented to a very limited degree in PHC. The objective of the study was to qualitatively assess how general practitioners (GPs) and nurses perceive the application of the three key priority-setting criteria.

Methods

Focus groups were held with GPs and nurses at primary health care centres, where the staff had a short period of experience in using the criteria for prioritising in their daily work.

Results

The staff found the three key priority-setting criteria (severity, patient benefit, and cost-effectiveness) to be valuable for priority setting in PHC. However, when the criteria were applied in PHC, three additional dimensions were identified: 1) viewpoint (medical or patient's), 2) timeframe (now or later), and 3) evidence level (group or individual).

Conclusions

The three key priority-setting criteria were useful. Considering the three additional dimensions might enhance implementation of national guidelines in PHC and is probably a prerequisite for the criteria to be useful in priority setting for individual patients.

“…..….Priority setting can be defined as making a choice based on a ranking process, although occasionally the term is used as a synonym for rationing or resource allocation [1,2]. Prioritising takes place in all parts of the health care system where demands and needs exceed resources. Decisions on priority setting are made at different levels [3,4]. General policy decisions are made at national and regional levels, as are comprehensive decisions on resource allocation, systems for financing providers, and national guidelines including priority setting for management of common diseases.

 

This paper addresses primary care, where priorities are set on a practical, individual level.

In Sweden nearly all health care is publicly financed through taxes, and the entire population is insured. Each primary health care centre is funded based on the number of patients linked to the centre, and in some instances the number of visits determines a small portion of the budget. Hence, each primary health care centre receives a limited, fixed budget to serve its patients…..” from background….

 

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