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OECD: Nye roller til danske læger og sygeplejersker
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First published December 1, 2016
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March 21, 2017
OECD: Nye roller til danske læger og sygeplejersker
OECD rapport om dk sundhed 2016
1. Experience in Ontario and elsewhere also signals how more could be made of the nursing role. The activities of Denmark’s 10 000 primary care nurses (not including health and social care assistants) remain relatively undeveloped compared to other Nordic countries, the Netherlands or England. Danish nurses are not allowed to prescribe, for example, despite the fact that almost all municipalities reportedly want nurses to be able to and the fact that nurse prescribing is well-established in other OECD health systems. More generally, there is very little post-graduate nurse training available in Denmark. This means that even though the FFS schedule in theory allows nurses to take on some tasks traditionally performed by doctors, such task-substitution rarely occurs and innovative service delivery models are held back.
40. Development of the nursing profession an important priority therefore, which can draw from substantial international experience and which has significant potential to transform primary care. Initial steps would include allowing nurses to prescribe medicines that can be bought over-the-counter, and setting up more nurse-led clinics focussed on preventive health care and health promotion for selected patient groups. Over the longer term, nurse-led clinics for the management of patients with some chronic diseases should be pursued, as already happens in England and other OECD health systems. The Dansk Sygeplejeråd, or Danish Nurses’ Organization, should take a more proactive role here than it has in the
Mer rygning og fedme i udkant end ved byer. It also suggests there is a need to strengthen the health literacy of poorer populations so they can understand the impacts of risk-taking behaviours and are empowered to engage in self-management of chronic disease.
10. It is surprising that Denmark still relies on GPs to perform telephone triage when many other countries use nurses to perform this function. This is likely to be in part to resistance from the doctors’ lobby. Such resistance was clearly manifest by the PLO’s advice to members to boycott the OOH model in the capital region, because of nurses’ participation in telephone triage (PLO, 2013), even though it was designed to increase choice and access for patients.
Ex på noget, vi kunne gøre i UCC
114. Denmark should therefore explore the feasibility of moving towards a nurse-led telephone-triage system in OOH services. This could be done under the supervision of GPs, as with the Netherlands model. A pilot of this model outside the Copenhagen region should be considered as part of the 2017 health agreement. To alleviate concerns about the impact on patient safety, a randomised controlled trial should be conducted, comparing nurse telephone triage and GP telephone triage, and the impact on patient outcomes. If findings are positive, Denmark should consider implementing this model across the country. Denmark could also consider piloting the integration of the out-of-hours primary care centre with the hospital emergency department, starting with a small-scale pilot and rolling out the model if it is proven to be effective in reducing self-referrals to emergency departments, without compromising on patient safety and satisfaction.
Lover health litteracy fremhæves som problem flere gange, jvf Simons ide.
Nurse practitioners do not exist in Denmark, in contrast to many other comparable countries. For example, nurse practitioners are reasonably well-established in primary care in Sweden. Their functions include independently taking care of conditions such as upper pulmonary infections, urinary tract infections, otitis, dermatitis and skin problems (Lindblad et al, 2010). In another model that Denmark could consider, the United Kingdom has minor injury units led by nurse practitioners. One of the goals of these units is to help avoid unnecessary OOH visits to emergency departments by treating patients who can be appropriately managed in that setting (Berchet and Nader, 2016).
169. A crucial part of person-centred care is giving patients the tools they need to play an active role in making decisions about their health care. Denmark is a forerunner in making data more accessible and more comprehensible to patients through the website sundhed.dk. The portal is a single digital space where Danish citizens can find information on waiting times, patient satisfaction and a range of quality indicators,
170. There is still scope, however, for patients to play a more substantial role in making decisions about their care. Clinicians need to be trained and supported to understand not only patient symptoms, but also their values and preferences, and how they can empower patients to be more involved. They need to be equipped with the skills to communicate with patients knowledge about their condition, what they can do to engage in self-management, and where they can get more information about their condition. Among the tools that can facilitate dialogue between clinicians and patients is decision aids. These tools help patients make decisions about the benefits, risks and costs of treatment alternatives.
OECD rapport om dk sundhed 2016
1. Experience in Ontario and elsewhere also signals how more could be made of the nursing role. The activities of Denmark’s 10 000 primary care nurses (not including health and social care assistants) remain relatively undeveloped compared to other Nordic countries, the Netherlands or England. Danish nurses are not allowed to prescribe, for example, despite the fact that almost all municipalities reportedly want nurses to be able to and the fact that nurse prescribing is well-established in other OECD health systems. More generally, there is very little post-graduate nurse training available in Denmark. This means that even though the FFS schedule in theory allows nurses to take on some tasks traditionally performed by doctors, such task-substitution rarely occurs and innovative service delivery models are held back.
40. Development of the nursing profession an important priority therefore, which can draw from substantial international experience and which has significant potential to transform primary care. Initial steps would include allowing nurses to prescribe medicines that can be bought over-the-counter, and setting up more nurse-led clinics focussed on preventive health care and health promotion for selected patient groups. Over the longer term, nurse-led clinics for the management of patients with some chronic diseases should be pursued, as already happens in England and other OECD health systems. The Dansk Sygeplejeråd, or Danish Nurses’ Organization, should take a more proactive role here than it has in the
Mer rygning og fedme i udkant end ved byer. It also suggests there is a need to strengthen the health literacy of poorer populations so they can understand the impacts of risk-taking behaviours and are empowered to engage in self-management of chronic disease.
10. It is surprising that Denmark still relies on GPs to perform telephone triage when many other countries use nurses to perform this function. This is likely to be in part to resistance from the doctors’ lobby. Such resistance was clearly manifest by the PLO’s advice to members to boycott the OOH model in the capital region, because of nurses’ participation in telephone triage (PLO, 2013), even though it was designed to increase choice and access for patients.
Ex på noget, vi kunne gøre i UCC
114. Denmark should therefore explore the feasibility of moving towards a nurse-led telephone-triage system in OOH services. This could be done under the supervision of GPs, as with the Netherlands model. A pilot of this model outside the Copenhagen region should be considered as part of the 2017 health agreement. To alleviate concerns about the impact on patient safety, a randomised controlled trial should be conducted, comparing nurse telephone triage and GP telephone triage, and the impact on patient outcomes. If findings are positive, Denmark should consider implementing this model across the country. Denmark could also consider piloting the integration of the out-of-hours primary care centre with the hospital emergency department, starting with a small-scale pilot and rolling out the model if it is proven to be effective in reducing self-referrals to emergency departments, without compromising on patient safety and satisfaction.
Lover health litteracy fremhæves som problem flere gange, jvf Simons ide.
Nurse practitioners do not exist in Denmark, in contrast to many other comparable countries. For example, nurse practitioners are reasonably well-established in primary care in Sweden. Their functions include independently taking care of conditions such as upper pulmonary infections, urinary tract infections, otitis, dermatitis and skin problems (Lindblad et al, 2010). In another model that Denmark could consider, the United Kingdom has minor injury units led by nurse practitioners. One of the goals of these units is to help avoid unnecessary OOH visits to emergency departments by treating patients who can be appropriately managed in that setting (Berchet and Nader, 2016).
169. A crucial part of person-centred care is giving patients the tools they need to play an active role in making decisions about their health care. Denmark is a forerunner in making data more accessible and more comprehensible to patients through the website sundhed.dk. The portal is a single digital space where Danish citizens can find information on waiting times, patient satisfaction and a range of quality indicators,
170. There is still scope, however, for patients to play a more substantial role in making decisions about their care. Clinicians need to be trained and supported to understand not only patient symptoms, but also their values and preferences, and how they can empower patients to be more involved. They need to be equipped with the skills to communicate with patients knowledge about their condition, what they can do to engage in self-management, and where they can get more information about their condition. Among the tools that can facilitate dialogue between clinicians and patients is decision aids. These tools help patients make decisions about the benefits, risks and costs of treatment alternatives.
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