Ministry of Social Affairs and Health

Objective The multidisciplinary team (MDT) approach in primary care is a relatively recent innovation, developed over the past 15 years. There is limited data on MDTs’ effects on Quadruple Aim (QA) goals. The object of this study is to evaluate the implementation of a novel MDT from 2021 to 2023 and its impact on access and continuity of care, compared to an established model. Future research will explore its effects on staff satisfaction, costs, and health outcomes. Design, setting and patients This quasi-experimental study compares five intervention health centers with three control centers. It includes all primary care patients from 2021 to 2023, presenting data on access and continuity before and after the intervention. Intervention Nurse-only consultations were replaced with a multidisciplinary nurse-physician model to address issues during initial contact more effectively. Nurses also took on the role of case managers, enhancing relational continuity. Lean daily visual management with continuous improvement, strategic goal setting, and coaching leadership style were implemented. Main outcome measures Access was measured using the ‘third available appointment’ (T3) metric, and continuity with the COC-index, both for physicians only. Results Access improved at all intervention centers, with T3 reduced from 90 to 1.125–4.75 days, while controls remained at 90 days. COC improved at three intervention centers but declined at two, with declines also observed at control centers. Conclusion The novel MDT enhanced primary care access compared to the traditional model. However, relying solely on T3 may be insufficient for evaluating effectiveness. Mixed results in continuity underscore the need for further investigation.

BackgroundSleep problems are common in psychotic disorders and are associated with worse quality of life and disease prognosis. Genome-wide association studies (GWAS) have revealed genetic influences for schizophrenia and sleep, but polygenic scores (PGSs) for sleep traits have not been evaluated systematically in patients with psychotic disorders.MethodsThis study investigated the associations between PGSs for sleep traits (insomnia, PGSINS; sleep duration, PGSSD; short sleep duration, PGSSS; long sleep duration; PGSLS), diurnal preference (eveningness, PGSME), and schizophrenia (PGSSZ) with clinical features of psychotic disorders in the Finnish SUPER study comprising 8,232 patients with psychotic disorders. The measures included self-reported sleep and well-being, cognitive assessments, clozapine use, and functional outcomes. Using FinnGen data of 356,077 individuals, we analyzed the distributions of PGSs in psychotic and bipolar disorders and the general population.ResultsPGSINS associated with more sleep problems and worse well-being (e.g. worse health-related quality of life [β = −0.07, CI = −0.09, −0.05, p < .001]). High PGSSZ is associated with better sleep quality, worse clinical outcomes, and performance in cognitive tests (e.g. more errors in paired-associated learning [β = 0.07, CI = 0.04, 0.09, p < .001]). PGSINS was higher in affective psychotic and bipolar disorders, while PGSSD and PGSME were higher in schizophrenia as compared with individuals with no psychiatric disorders.ConclusionGenetic risks for sleep and diurnal preference vary between non-affective psychosis, affective psychosis, and the general population. The findings in this study emphasize the heterogeneity in genetic etiology of the objective features of disease severity and the more subjective measures related to well-being and self-reported measures of sleep.

This career path interview describes the work of an expert in work and organizational psychology in the Finnish central government at the Ministry of Social Affairs and Health. Research and policy are combined in the work of the Ministry’s senior specialist. Mental health problems are a key factor causing sick leaves in Finnish work life and promoting mental health and preventing problems are a key objective that is promoted through various practical measures.

The Finnish web-based Meds75+ database supports rational, safe and appropriate prescribing to older adults in primary care. This article describes the content and updating process of Meds75+ and demonstrates its applicability in everyday clinical practice. Meds75+ contains a classification (A-D) and recommendation texts for 450-500 drug substances when used in the treatment of older adults aged 75 years or older. The content of Meds75+ is continually updated. Each assessment of a drug substance begins with a structured collection of available information and research evidence. After that, an interdisciplinary expert panel discusses the classification and recommendation using a consensus method. A rolling 3-year updating cycle guarantees that all drug substances are reviewed regularly. Most drug substances are classified as class A (41%) (suitable, e.g. bisoprolol) or as class C (37%) (suitable with specific precautions, e.g. ibuprofen). One-fifth (20%) of the substances are in class D (avoid use, e.g. diazepam). Most commonly, older adults have purchased substances affecting the alimentary tract and metabolism (17%), the nervous system (16%) and the cardiovascular system (15%). In Finland, the proportion of older adults using class D substances (37%) has not changed between the years 2019 and 2022. Meds75+ has potential to support safer and more effective use of medications for older adults, since it offers up-to-date information on drug substances for healthcare professionals.

Coordinating services for people with disabilities requires the expertise of professionals who promote the employment and work ability of their clients. This study evaluated the effects of work ability coordinators’ educational program on behavior of professionals who support work ability of people with disabilities. The participants were 394 professionals aged from 27 to 63 (mean age 46), who attended 21 educational programs in different parts of Finland during 2016–2019. As evaluation methods we used questionnaires and content analysis. The participants’ knowledge and skills, as their capabilities to provide work ability support to people with disabilities increased statistically significantly during the educational program. Motivation meant that the participants expected to gain knowledge on the broad structure of the service system and legislation. Networking opportunities led to new, individual-based contacts and co-operation at the national as well as the regional level. Behavior change meant that the use of the solution-focused approach to work and the full range of measures to support work ability and employment of persons with disabilities in the service system had been successful. The results will guide future educational programs and policy decisions on the proficiency needs of professionals working in the service system.

Abstract Objectives In axial spondyloarthritis (axSpA), switching between multiple biologic or targeted synthetic (b/ts-) DMARDs might indicate difficult-to-treat disease. We aimed to explore the occurrence of multiple switching in routine care axSpA patients using various definitions, and to identify associated clinical characteristics upon start of first b/tsDMARD (baseline). Methods Observational cohort study including patients with axSpA starting a first-ever b/tsDMARD 2009–2018 based on data from five biologic registries (Denmark/Sweden/Finland/Norway/Iceland). Comorbidities and extra-articular manifestations were identified through linkage to national registries. Multi-switching was defined in overlapping categories according to b/tsDMARD treatment history: treatment with ≥3, ≥4 or ≥5 b/tsDMARDs during follow-up. We explored the cumulative incidence of patients becoming multi-switchers with ≥3 b/tsDMARDs stratified by calendar-period (2009–2011, 2012–2013, 2014–2015, 2016–2018). In the subgroup of patients starting a first b/tsDMARD 2009–2015, baseline characteristics associated with multi-switching (within 3 years’ follow-up) were explored using multiple logistic regression analyses. Results Among 8398 patients included, 6056 patients (63% male, median age 42 years) started a first b/tsDMARD in 2009–2015, whereof proportions treated with ≥3, ≥4 or ≥5 b/tsDMARDs within 3 years’ follow-up were 8%, 3% and 1%, respectively. Calendar-period did not affect the cumulative incidence of multi-switching. Baseline characteristics associated with multi-switching (≥3 b/tsDMARDs) were female gender, shorter disease duration, higher patient global score, comorbidities and having psoriasis but not uveitis. Conclusion In this large Nordic observational cohort of axSpA patients, multiple switching was frequent with no apparent time-trend. Clinical associated factors included gender, but also previous comorbidities and extra-articular manifestations illustrating the ongoing challenge of treating this patient group.

BackgroundIt is assumed that the implementation of health information technology introduces new vulnerabilities within a complex sociotechnical health care system, but no international consensus exists on a standardized format for enhancing the collection, analysis, and interpretation of technology-induced errors.ObjectiveThis study aims to develop a classification for patient safety incident reporting associated with the use of mature electronic health records (EHRs). It also aims to validate the classification by using a data set of incidents during a 6-month period immediately after the implementation of a new EHR system.MethodsThe starting point of the classification development was the Finnish Technology-Induced Error Risk Assessment Scale tool, based on research on commonly recognized error types. A multiprofessional research team used iterative tests on consensus building to develop a classification system. The final classification, with preliminary descriptions of classes, was validated by applying it to analyze EHR-related error incidents (n=428) during the implementation phase of a new EHR system and also to evaluate this classification’s characteristics and applicability for reporting incidents. Interrater agreement was applied.ResultsThe number of EHR-related patient safety incidents during the implementation period (n=501) was five-fold when compared with the preimplementation period (n=82). The literature identified new error types that were added to the emerging classification. Error types were adapted iteratively after several test rounds to develop a classification for reporting patient safety incidents in the clinical use of a high-maturity EHR system. Of the 427 classified patient safety incidents, interface problems accounted for 96 (22.5%) incident reports, usability problems for 73 (17.1%), documentation problems for 60 (14.1%), and clinical workflow problems for 33 (7.7%). Altogether, 20.8% (89/427) of reports were related to medication section problems, and downtime problems were rare (n=8). During the classification work, 14.8% (74/501) of reports of the original sample were rejected because of insufficient information, even though the reports were deemed to be related to EHRs. The interrater agreement during the blinded review was 97.7%.ConclusionsThis study presents a new classification for EHR-related patient safety incidents applicable to mature EHRs. The number of EHR-related patient safety incidents during the implementation period may reflect patient safety challenges during the implementation of a new type of high-maturity EHR system. The results indicate that the types of errors previously identified in the literature change with the EHR development cycle.

Terveydenhuollossakin sovellettava lean-ajattelu korostaa jatkuvaa parantamista ja lisäarvon tuottamista asiakkaille. Lean-päivittäisjohtamisen piirteitä ovat mittaamisen ja lean-taulujen avulla tapahtuva visuaalinen seuranta, vastuu toiminnasta ja päivittäiset lyhyet moniammatilliset tiimikokoukset. Tämän tutkimuksen tarkoituksena oli tunnistaa lean-päivittäisjohtamisen piirteitä ja siihen liittyvää osaamista sekä lean-ajattelun hyödynnettävyyttä yliopistosairaaloissa. Aineisto kerättiin neljästä suomalaisesta yliopistosairaalasta lean-ajattelua soveltavilta asiantuntijoilta kyselyillä (N = 41) ja teemahaastatteluilla (N = 15) marraskuun 2017 ja kesäkuun 2018 välillä. Aineistot analysoitiin aineisto- ja teoriaohjaavalla sisällönanalyysilla. Lean-ajattelun periaatteet sopivat yliopistosairaaloihin. Lean-ajattelun soveltaminen edellyttää valmentavaa johtamista ja koko henkilöstön sitoutumista, organisaation eri tasoilla. Soveltamista rajoittaa osa terveydenhuollon kulttuurin piirteistä: hierarkkisuus, menettelytapojen kankeus ja epäselvät prosessit. Lean-ajattelun periaatteita ja työkaluja käytettäneen tulevaisuudessakin, mutta ajattelumallin odotetaan muokkaantuvan ja hyödyn paranevan, kun lean-ajattelu yhdistetään muihin johtamis- ja kehittämismalleihin. Lean-päivittäisjohtamisen ei arvioitu olevan vakioitunutta yliopistosairaaloissa, mutta sen piirteitä tunnistettiin ja samalla tarve niiden vahvistamiseen. Piirteitä ovat kommunikaatio ja viestintä, mittaaminen ja seuranta, osaamisen hallinta, valmentava johtaminen, tiimityön ja muutoksen tukeminen, jatkuva parantaminen, hukan poistaminen sekä strategian mukainen toiminta ja tavoitteiden asettaminen. Lean-ajattelun systemaattinen soveltaminen terveydenhuollon organisaatioissa edellyttää selkeitä strategiassa kuvattuja visiota ja tavoitteita, jalkautussuunnitelmaa sekä johdon ja henkilöstön sitoutumista siihen. Lean-päivittäisjohtamisen vahvistamiseksi tarvitaan jatkuvan parantamisen menettelyjen ja seurantamittareiden systemaattista kehittämistä.

The International Journal of Integrated Care (IJIC) is an online, open-access, peer-reviewed scientific journal that publishes original articles in the field of integrated care on a continuous basis.IJIC has an Impact Factor of 5.120 (2020 JCR, received in June 2021)