The document discusses challenges posed by Denmark's growing elderly population from the perspective of patients. It notes that the population and those over 65 will significantly increase by 2050. This will challenge the healthcare system as the elderly tend to have multiple chronic conditions and complex needs. To better serve patients, the system must provide information, involve patients in decision-making, and consider their perspectives and resources. The Danish Patients organization and its ViBIS knowledge center aim to enhance patient involvement in healthcare to improve services and quality of care.

1. The
growing
elderly
popula1on
-­‐
a
pa1ents’
perspec1ve
on
challenges
an
solu1ons
in
healthcare
Anne%e
Wandel
Chief
consultant
www.danskepa7enter.dk
15.
maj
2012

2. My
presenta1on
• About
Danish
Pa7ents
and
ViBIS
• The
aging
popula7on
in
Denmark
• Challenges
for
the
healthcare
system
• Solu7ons
from
a
pa7ents’
perspec7ve
15.
maj
2012

3. Danish
Pa1ents
• Umbrella
organiza7on
• 79
pa7ent
organiza7ons
• Represen7ng
860,000
members
• 10
employees
including
ViBIS
• The
Danish
Knowledge
Center
of
User
Involvement
in
Health
Care
15.
maj
2012

4.
Danish
Pa1ents
is
working
for:
Securing
pa7ents
the
best
possible
condi7ons
in
the
health
care
system,
through:
Ø developing
policies
based
on
documented
knowledge
of
pa7ents’
perspec7ves
Ø being
the
voice
of
pa7ents
in
rela7on
to
authori7es
and
the
public
15.
maj
2012

5. 15.
maj
2012

6. ViBIS
• The
Knowledge
Center
is
established
in
2011
to
enhance
involvement
of
pa7ents
and
rela7ves
in
health
care
• The
Knowledge
Center
is
working
to
raise
the
standards
of
prac7ce
involving
pa7ents
and
rela7ves
in
health
care
on
a
individual
and
organiza7onal
level
15.
maj
2012

7. Gathering
Analyzing
Communica1ng
Assesment
Via
:
Ongoing
project
Filtering
-­‐
Website
Ongoing
prac7ce
-­‐
Advising
Li%erature
study
-­‐
Courses
including
interna7onal
-­‐
Facilita7ng
experience
What
is
meaningful
userinvolvement?
Many
different
intepre7ons
of
user-­‐
involvement
15.
maj
2012

8. The
healthcare
system:
Ø Provides
sufficient
informa7on
Ø Communicates
with
pa7ent
(and
rela7ves)
about
individual
needs
for
informa7on
Ø Requestes
and
involves
the
pa7ents’
knowledge,
preferences
and
resources
througout
the
course
of
treatment
Ø Pra7ce
shared
decision
making
Ø Empowers
pa7ents
to
handle
the
situa7on
living
with
a
disease
Ø Systema7cally
collect
and
emplement
pa7ents’
knowledge
on
a
organiza7onel
level
to
improve
quality
of
health
care
services
Ø Systema7cally
collect
and
apply
pa7ent
evalua7on
of
the
health
care
services
15.
maj
2012

9. 15.
maj
2012

10. Predic7on
of
eldery
Source: Nyt fra Danmarks statistik, nr. 205, 4. maj 2011.
www.dst.dk/pukora/epub/Nyt/2011/NR205.pdf
15.
maj
2012

11. Significant
growing
number
of
elderly
people
• Popula7on
will
increase
to
6.1
mio.
in
2050
from
5.6
mio.
today
• Number
of
people
over
65
years
old
will
increase
to
1.5
mio.
in
2044
from
934,000
today
• A
growth
57
pct.
more
people
over
65
years
old
15.
maj
2012

12. Chronic
diseases
2.500.000
2.000.000
1.500.000
1.000.000
500.000
0
1987
2005
2020
http://www.si-folkesundhed.dk/upload/
kap_35_folkesundheden_i_fremtiden.pdf
15.
maj
2012

13.
Diagnosis
related
to
lifestyle
700.000
600.000
500.000
400.000
300.000
200.000
100.000
0
Diabetes
Cardio
Lung
Rheuma
Psych
Source:www.sst.dk/Planlaegning%20og%20kvalitet/Kronisk%20sygdom/
15.
maj
2012
SST_proj_forst_inds/Monitorering%20af%20kronisk%20sygdom.aspx

14.
Mul1
disease
1.000.000
900.000
800.000
700.000
600.000
500.000
400.000
Number
of
people
300.000
200.000
13.052 1.048
100.000
0
one
two
three
four
five
diagnosis
diagnosis
diagnosis
diagnosis
diagnosis
15.
maj
2012

15. Change
in
disease
paIern
• 1.7
mio.
living
with
a
chronic
disease
• Complexity
is
growing
• The
capability
of
handling
a
life
with
disease
is
increasingly
important
Ø INVOLVING
PATIENTS’
RESOURCES
ARE
CRUCIAL
TO
TREATMENT
Ø COHERENCE
IS
BECOMING
MORE
CHALLENGING
15.
maj
2012

16. Change
in
pa1ent
role
• Seeking
informa7on
• Knowledge
of
disease
and
treatment
• Increasing
demands
for
coopera7on
Ø PATIENTS
HAVE
RESOURCES
AND
WANT
TO
BE
INVOLVED
15.
maj
2012

17. Davids
case
The
case
illustrates
the
challenges
securing
coherence
between
different
faces
throughout
his
course
of
treatment:
diagnosis,
treatment
and
rehabilita7on
–
and
the
daily
life
of
David.
15.
maj
2012

18. Davids
case
David
is
a
50
year
old
man
Works
as
a
sales
manager
Lives
with
his
family:
two
children
and
his
wife.
One
day
he
collapses
at
work
with
chest
pain
His
workplace
calls
an
ambulance
He
is
admi%ed
on
the
emergency
ward
David
has
had
a
heart
a%ack
–
and
is
diagnosed
with
diabetes
His
is
hospitalized
at
the
cardiac
ward
15.
maj
2012

19. System
perspec1ve
Emergency
Out-­‐pa7ents
Hospitalized
Discharged
Rehabilita7on
ward
visit
Emergency
Out-­‐pa7ents
Hospitalized
Discharged
Rehabilita7on
Ward
visit
15.
maj
2012

20. Pa1ent
perspec1ve
The
Out-­‐pa7ent
podiatrist
cardiac
ward
Pa7ent
educa7on
program
The
The
cardiac
rehabilita7on
ward
center
The
acute
ward
Caseworker
The
General
Municipality
diabetes
prac77oner
ward
15.
maj
2012

21. 15.
maj
2012

22. ”
There
must
be
unity
in
things
.......
Organs infected by disease
and
it
all
hang
together
....
But
frequently
you
find
that
when
you
arrive
at
the
eye
ward
so
even
though
they
are
nice
and
competent
and
everything,
you
are
a
pair
of
giant
eyes
with
legs
that
comes
walking
down
the
hallway.
And
the
same
on
the
diabetes
ward
-­‐
there
you
are
a
large
pancreas
with
legs
.....
and
on
vascular
surgery
ward,
there
One person
you
are
a
pounding
vein
walking
......
they
do
not
see
the
whole
person
"
(Pa/ent,
DSI,
2010)
15.
maj
2012

23.
Different
professionals
"It's
weird,
because
it's
only
one
thing
that
the
hospital
staff
are
looking
at
and
my
doctor,
she
does
not
really
look
at
that,
because
she
expects
that
the
hospital
takes
care
of
it.
So
you
feel
a
bit
like
one
is
a
jigsaw
puzzle.
With
one
piece,
you
can
go
there
and
they
can
look
at
it
and
maybe
take
care
of
it,
but
the
rest
is
not
their
business.
“
(EfB,
2007)
Only
one
to
create
coherence
15.
maj
2012

24. Pa1ent
in
hospital
”
It's
very
frustra7ng
to
wait
for
a
phone
call
that
never
comes.
It
is
7me
consuming
and
it
costs
working
7me.
Many
conversa7ons
with
the
clinic
is
not
suitable
to
be
placed
in
open
workspaces
-­‐
so
I
may
have
to
take
7me
off
or
a
sick
leave”.
A
person
Pa/ent,
Det
borgernære
Hospital,
2010
15.
maj
2012

25.
Patient
Focus on individual needs
Involvement
(Needs/Demands)
Coordination
Holistic view
Unsolved
Access
dilemma
Centralization
Specialization
Standardization
System
(Development)
15.
maj
2012

26. Solu1ons
Ø Involvement
of
pa7ent
and
rela7ves
Ø Coherence
throughout
the
course
of
treatment
15.
maj
2012

27. Effects
of
involving
pa1ents
• It
has
been
documented
that
pa7ent
involvement
has
a
posi7ve
effect:
– Quality
of
life
and
pa7ent
sa7sfac7on
– Clinical
outcome
– Pa7ent
safety
– Changes
in
the
provision
of
services
Source:
Coulter
A,
Ellins
J.
Pa7ent-­‐focused
interven7ons
–
A
review
of
the
evidence.
London:
The
Health
Founda7on,
2006.
15.
maj
2012

28. At
the
individual
level
Professional
D
Pa7ent
E
-­‐
Experience
-­‐
Treatment
methods
C
-­‐
History
of
treatment
-­‐
Effects
I
-­‐
Overall
disease
-­‐
Adverse
effects
S
picture
-­‐
Risks
I -­‐
Life
situa7on
O
N
-­‐
Preferences
15.
maj
2012

29. At
the
organiza1onal
level
Effects
Adverse effects
Solution
Risks
…….
Clinical
Economic
Pa7ent
Experience
Life situation
Workplace Organisa7on
Preferences
Cooperation
…….
……..
15.
maj
2012

30. Adverse
events
–
an
individual
level
• Pa7ents
and
rela7ves
have
important
knowledge
• Pa7ents
detect
other
types
of
errors
and
incidents
than
do
staff
-­‐
e.g.
in
pa7ent
handover/transi7ons
• 24
%
experience
adverse
events
during
hospital
stay
–
54
%
detect
the
event
themselves
• Pa7ents
can
be
used
as
informants
in
order
to
prevent
medical
errors
and
to
improve
knowledge
on
adverse
events
Source:
Unit
of
pa7entperceived
quality,
2008:
h%p://www.pa7entoplevelser.dk/log/medie/Rapporter/2008/TUP_2007.pdf
15.
maj
2012

31. Involvement
on
an
organiza1onal
level
• 1.
september
2011
pa7ents
and
rela7ves
have
been
able
to
report
adverse
events
to
a
central
database
by
law
• The
informa7on
is
gathered
and
analyzed
in
Pa/entombuddet
–
and
commits
the
regions,
municipali7es
and
the
GP´s
to
act
on
reports
to
improve
pa7ent
safety
15.
maj
2012

32. 4-­‐month
period
of
repor7ng
adverse
events
More
than
35,000
over
the
course
of
last
year
15.
maj
2012

33. Status
in
Denmark
• Informed
consent
• ”Regions
and
municipali7es
have
to
secure
quality
and
efficient
use
of
resources…in
dialog
with
the
users…”
• A
lot
of
individual
smaller
projects
• Pa7ent
representa7ves
in
a
lot
of
bodies
15.
maj
2012

34. Goals
for
Danish
Pa1ents
• Systema7c
approach
defining
how
• Systema7c
evalua7on
• Legisla7on
can
support
that
(Norway)
15.
maj
2012

35. Coherence
15.
maj
2012

36.
Telemedicine
Involvement
Patient
Holistic view
Focus on individual needs
(Needs/Demands)
Coordination
Access
Work,
Involvement
of
family
pa7ent
and
Coherence
ect.
rela7ves
Easier
and
wider
Centralization
Specialization
Standardization
System
(Development)
15.
maj
2012

37. Status
in
Denmark
• A
lot
of
smaller
projects
• 2012-­‐15
some
large
scale
project
• Telemedicine
is
supported
by
0,0068
%.
of
the
expenses
on
health
care
on
public
hospitals.
Source:
h%p://www.ssi.dk/Sundhedsdataogit/Na7onal%20Sundheds-­‐it/Aktuelt/2011/~/media/Indhold/DK%20-­‐%20dansk/Sundhedsdata%20og%20it/Na7onal%20Sundheds-­‐it/Nyheder/
21102011/DialogudgaveAfNa7onalStrategiForTelemedicin.ashx
15.
maj
2012

38. Goals
for
Danish
Pa1ents
• More
larger
scale
projects
• Quality
–
not
saving
money
• Coherency
–
not
single
body
projects
• Individual
needs
–
not
one
size
fits
all
• User
innova7on
–
not
driven
by
technology
15.
maj
2012