In the late seventies the World Health Organization developed a strategy of Health for all towards year 2000, to which Norwegian health authorities have consented. This article presents and discusses the sub-goals for expectation of life and mortality, and analyzes the possibilities of reaching them. The desired reduction of at least 25% in accident mortality rates and cardiovascular mortality rates in relation to the reference period 1976-80 will probably be reached. In addition, the desired 15% reduction in cancer mortality is likely to be reached for persons under 40 years of age. Infant mortality does not appear to be declining, cancer mortality for people over 40 years of age is increasing, and the suicidal and homicidal rates are increasing faster than any other cause of death. The possibilities of reversing this development require a structured plan and comprehensive changes in the way society is organized, with more emphasis on care, social network planning and reduction of the multicausal risk load that modern life implies. Some of the sub-goals are not sufficiently founded on accessible information, and should be revised.
OBJECTIVE: To identify and explore the components of patient satisfaction that have the strongest association with health-related quality of life among patients with angina. DESIGN: Cross-sectional study with postal questionnaires sent to patients 6 weeks after discharge from hospital, followed-up by one reminder. SETTING: The Central Hospital of Akershus in Norway. STUDY PARTICIPANTS: All 589 angina patients discharged between January 1 1995 and December 31 1996. The response rate was 67% (n=395). MAIN OUTCOME MEASURES: Physical and mental component summary scales in SF-36. RESULTS: When adjusted for relevant background factors such as age, sex, education, social network, health behaviour and sense of coherence, patient satisfaction explained 9% of the variation in the physical, and 7% of the variation in the mental component summary scales. In particular, satisfaction with medical treatment (P=0.002) and with information (P=0.003) were associated with improved physical and mental health-related quality of life. Patients who experienced their physicians as caring and competent were more likely to be satisfied with the medical treatment and with the information. Sense of coherence contributed to health-related quality of life both directly, and through improving patient satisfaction. CONCLUSION: This cross-sectional study supports the hypothesis that patient satisfaction contributes to both physical and mental health-related quality of life. Other research designs are needed to assess whether the associations identified are truly causal.
The objective of this study was to estimate the cost of medical treatment of injuries in Norway. We analysed aggregated data from two sources, the National Hospital Discharge Register and the National Injury Register, in order to calculate such costs in 1994. Approximately 400,000 injuries treated in hospitals and emergency departments in 1994 cost NOK 1.7 billion in terms of medical treatment. Unintentional injuries accounted for 91%, self-inflicted injuries for 3%, and injuries stemming from violence for 6% of the costs. Injuries requiring hospitalisation accounted for 71% of the total costs. Persons aged 65 years or more constituted 14% of the cases but accounted for 46% of the cost of treating unintentional injuries. Injuries at home or during leisure time accounted for 75% of the costs of the unintentional injuries, while traffic injuries accounted for 7%, occupational injuries for 8%, and 10% of the costs could not be classified. Hip fractures alone accounted for 27% of the total costs. Traffic and occupational injuries remain important targets for prevention, but greater efforts are required to reduce risk of injuries in the home and during leisure time, injuries to elderly people, hip fractures, and injuries that stem from violence.
This study was performed to investigate to which extent job satisfaction and psychosocial working environment could explain variations in patient satisfaction with treatment and care. Questionnaires were mailed to nursing staff and to patients in 17 in-patient treatment units within two Norwegian hospitals. 2408 patients (61 per cent) replied on detailed questions concerning satisfaction with care, and 488 employees (78 per cent) replied on detailed questions concerning job satisfaction and psychosocial working conditions. Associations between 77 factors related to job satisfaction and 14 domains of patient satisfaction were assessed by simple correlations and multiple regression procedures using patient, employee and treatment ward as unit of analysis. Job satisfaction concerning bureucracy/organization, information from superiors, level of knowledge among leadership, economic constraints, collaboration, backup, stress, autonomy, skill, in-service training and fighting spirit were all significantly associated with various domains of patient satisfaction (all p values
Contrasts in life expectancy among countries are an important input for defining targets for the health service and for setting priorities for disease prevention and health promotion. In this article, the trend in life expectancy in Norway is compared with the trend in a selection of other OECD countries. Standardised measures of life expectancy were collected from WHO and OECD statistics. In 1960 Norwegians ranged among the top three countries as regards life expectancy for both women and men. In 1990 Norwegians ranged tenth for women and ninth for men. Life expectancy was two years shorter for Norwegian than for Japanese women in 1990, corresponding to a 20% surplus mortality throughout life. Similar differences were found for men. If Japanese age specific death rates are applied to the Norwegian population, this corresponds to a reduction of 9,600 deaths this year. The relatively unfavourable trend in life expectancy in Norway relative to other OECD countries raises concern, and should be considered when designing the future health policy.
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Comment In: Tidsskr Nor Laegeforen. 1996 May 20;116(13):1615-68685875
We have shown before that Norway is experiencing an unfavourable trend in life expectancy compared with Japan, France and several other OECD countries. In this article, we discuss the cause-specific differences in mortality that explain these contrasts. Heart infarction is the predominant cause of death in Norway, with a mortality five times higher than in Japan and three times higher than in France. Both Norway and France have three times higher mortality rates for breast cancer than found in Japan, and the mortality rate for cervical cancer is twice as high in Norway as in the two other countries. Norwegian women show a mortality rate for lung cancer that is twice as high as that of their French sisters. Suicide among young Norwegians is a rapidly growing problem, and twice as common among Norwegian men aged 20-24 than among Japanese men of the same age. We challenge the health authorities and the specialists in the relevant fields to reflect again on their preventive strategies, in light of these contrasts.
This study was designed to describe patients' experience with surgical treatment of epilepsy in terms of whether it was useful or had negative effects and to assess associations between experienced utility (satisfaction), experienced negative effects (dissatisfaction), and selected objective outcome measures. An evaluation of patients' satisfaction and dissatisfaction was conducted retrospectively by questionnaires for all patients surgically treated for epilepsy in Norway between 1949 and 1988. One hundred sixteen patients (74.3%) replied. Overall, 75% of the surgically treated patients reported that treatment had been useful, and 20% reported that the treatment had negative effects. The experience of satisfaction with treatment was strongly associated with a favorable seizure outcome, more severe underlying disease, improvements in working ability, being in regular work or education postoperatively, and not having disability pensions postoperatively. The experience of dissatisfaction with treatment was significantly associated with neurologic deficit and decreased working ability. There was overall agreement between subjectively reported satisfaction with treatment and success measured objectively. The experiences of useful effects and negative effects of the operation could not be represented by a single-dimension scale. Seizure outcome played a more important role in terms of reported useful effects, and neurologic deficit played a more important role in reported negative effects. In both categories, effects on social, occupational, emotional, and behavioral aspects played an important role.
The reliability and acceptability of a 39-question patient-satisfaction questionnaire (PS-RESKVA) for use in hospitals is assessed. Postal questionnaires were sent to 19,395 patients, aged between 15 and 100 years, who were discharged from the medical, surgical, gynaecological, and neurological wards of two Norwegian hospitals; they were followed up with one reminder. The response rate was 59% for all patients, and 71% among those who were considered medically capable of answering. Six underlying factors were identified in the PS-RESKVA profile, which contained 11 different aspects satisfaction. The PS-RESKVA satisfied the psychometric criteria for internal consistency. Results indicate that the PS-RESKVA is a possible measure of patient satisfaction after discharge from hospital. It seems acceptable to patients in general, and is a reliable measure of satisfaction for a wide range of patients. Further studies on its validity are warranted.
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Comment In: Tidsskr Nor Laegeforen. 1998 Feb 28;118(6):947-89543816
Until recently, post-war health care was characterized first by expansion and later by cost containment. We now appear to have entered a period focusing on assessment and accountability, often described as the outcomes movement. Patients' outcomes are regarded as the most important information on effectiveness and quality. The outcomes movement includes the traditional outcome measures of mortality and morbidity, as well as clinical endpoints, social, mental and physical well-being, general health, quality of life and patient satisfaction. Establishing the effectiveness of medical care in the "real world" is an important aspect of outcomes research. The article discusses the emergence of outcomes research, the central elements of outcomes management, and some critical views on the outcomes initiative.
