Improving health and welfare for the most fragile elderly

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Primary care and the care for the elderly
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Coordination of healthcare and welfare for the
elderly

• Improving healthcare and welfare for the most
  fragile elderly
• 500 million Euros 2011-2014
• Strengthening incentives and conditions for the
  county councils and the municipalities
• National coordinator

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Regional level County Councils - Providing health
and medical care

• Local Authorities
• Municipalities
• Social services, housing and
• home-based elderly care

• National level
• Parliament and Government
• Policy goals
• Legislation, Supervision, Financial control
  measures

18 County Councils 2 Regions
290 Municipalities
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Funding of healthcare

• County council taxes
• Supplemented by government grants
• Small user fees
• Long-term care for the elderly is financed and
  organized by the municipalities.

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Increased life expectancy
Percentage change in number of people per age
group 20102050. Source Statistics Sweden 2010
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Health care cost per year of age (SEK), 2004
Primary care
Inpatient care
Outpatient visits
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Current situation

• High quality healthcare and social care
• Ageing population
• Living longer with multiple health problems
• Limited knowledge on multimorbidity
• No uniform definition of multimorbidity

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How do we meet the needs of the elderly?

• Ask them!
• Healthcare systems that suit persons with
  multimorbidity
• System of free choise
• Open comparisons

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System of free choice

• Opportunity to choose provider of social services
  and primary care
• Move power from politicians to citizens
• Promote a diversity of providers
• Voluntary tool for municipalities
• Mandatory for Primary care

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Open comparisons

• Open presentation of results each year
• Health care and social care
• Promote discussions on quality and efficiency
• Peer pressure
• Transparency
• Political accountability

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Challenges

• Continuity and coordination
• Funding
• Competence
• Organisation of healthcare
• Improved use of medication
• Research in elderly care

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The role of primary care

• Homebased care
• Coordination of specialised care
• Pallliative care
• Care of persons with dementia
• Multipharmacy
• ??

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Palliative care

• All dying persons, regardless of diagnoses
• Homebased care
• Institutional care
• National guidelines
• Swedish Palliative register

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The Swedish palliative register

• Improve the care of terminally ill
• Support care units
• Continuous update
• Evaluation of pain, nausea and anxiety
• Information to patient and family

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One municipality
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Best municipality
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Care for persons with dementia

• Importance of early diagnose
• Structured treatment and care
• National guidelines
• Swedish Dementia register
• Dementia ABC primary care
• BPSD register

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Good use of medicines

• Unsuitable medicines for the elderly
• Unsuitable combinations of medicines
• Inadequate use of neuroleptics

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Coordinated and Integrated care

• Homebased care
• Prevention
• Avoidable hospital care
• Readmissions in 30 days

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Thanks for your attention!