Health and disability pension--an intersection of disease, psychosocial stress and gender. Long term follow up of persons with impairment of the locomotor system.

OBJECTIVES: To evaluate the outcome after 1, 2, 3 and 10 years of rehabilitation conducted by the Swedish Social Insurance Office, in relation to socioeconomic, psychosocial and gender aspects. STUDY DESIGN: A retro and prospective study of 372 individuals rehabilitated by the National Swedish Insurance Office 1993-1994. Diagnosis, socio demographic data, Sense of Coherence and Perceived Health were compared with register data in terms of sickness benefit and disability pension up to 10 years. RESULTS: At the 10 year follow up 52% of the men and 57% of the women were granted any kind of DP. 82% of the men with low PH and women with a PM or a low PH had any kind of benefit 10 year after rehabilitation started. High age and low PH increases the risk of a full DP after 3 as well as 10 years for both men and women. At the 3 year follow up however, low education was also important for a full DP for men and having a Psychosocial Marker for women. The factors civil status and kind of profession did not significantly relate to a full DP after 10 year. CONCLUSIONS: In different ways factors as age, education, psychosocial stress, Sense of Coherence and Perceived Health mediate the rehabilitation process in significant ways by affecting the manifestation of the disease itself and/or via the context in which the rehabilitation takes place, in combination with individual factors that acts over a long time. Age and Perceived Health seems to be the most important factors of them all.

Localized and generalized disorders of the locomotor system--psychosocial and gender aspects: a ten year follow-up of rehabilitation.

PURPOSE: To evaluate localized disorders (LD) and generalized disorders (GD) of the locomotor system to differences in gender, personal and psychosocial factors in relation to outcome 10 years after the rehabilitation was initiated. METHOD: A total of 372 individuals (174 men and 198 women) representing two diagnostic groups, localized disorder (LD) and generalized disorder (GD) of the locomotor system, were followed for 10 years with regard to sick benefit (SB) and disability pension (DP) in relation to psychosocial background, Sense of Coherence (SOC) and Perceived Health (PH). RESULTS: Men with GD were more often single and had a lower SOC. Women with GD had more psychosocial markers and worse PH. Women with GD were more often on sick leave three years after rehabilitation and more often claim SB as well as DP after 10 years. Men with a low SOC and women with only compulsory school education had an increased risk of having a GD. CONCLUSION: The presence of GD of the locomotor system could be a reminder of the advisability to explore the patient's psychosocial condition in order to improve medical as well as vocational rehabilitation.

Design and implementation of a point-of-care computerized system for drug therapy in Stockholm metropolitan health region--Bridging the gap between knowledge and practice.

INTRODUCTION: Stockholm County Council is the largest health care provider in Sweden with an annual budget of US$ 5 billion and catering the needs of a metropolitan population of 2 million people. About 10% of health care costs are used on drugs. In 1996 Stockholm County Council decided to address the main problems associated with the process and the quality of drug prescribing. METHODS: A multiyear strategy was designed, including the establishment of a strong evidence-based organisation, Drug and Therapeutics Committees and editorial resources to adapt information to the IT-media and the development of the IT-architecture. The development and implementation of computerized tools such as a physician drug order entry system including decision support, a drug information website and electronic transmission of prescriptions were started in 1996. RESULTS: The implementation was slow at the point-of-care units. It took about 6 years before the implementation process gained speed. In September 2005 almost 1000 doctors could use the decision support system for prescribing drugs and more than 70% of all prescriptions were transmitted electronically in our region. CONCLUSIONS: The work with the strategy has shown that improvements in drug use can be accomplished by providing access to simple, rapid and safe electronic tools, but the information provided has to be associated with well-recognized regional and national expert organisations.