Rognli, Eline B.; Støme, Linn Nathalie, Kvaerner, Kari Jorunn, Wilhelmsen, Christian & Arnevik, Espen Kristian Ajo (2022)
The effect of employment support integrated in substance use treatment: A health economic cost-effectiveness simulation of three different interventions
Background: Unemployment rates for individuals in treatment for substance use disorder (SUD) are high, with Norwegian estimates in the range of 81%–89%. Although Individual Placement and Support (IPS) represents a promising method to improved vocational outcome, cross-disciplinary investigations are needed to document implementation benefits and address reimbursements needs. The aim of this study was to model the potential socioeconomic value of employment support integrated in SUD treatment. Methods: Based on scientific publications, an ongoing randomised controlled trial (RCT) on employment support integrated in SUD treatment, and publicly available economy data, we made qualified assumptions about costs and socioeconomic gain for the different interventions targeting employment for patients with SUD: (1) treatment as usual (TAU); (2) TAU and a self-help guide and a workshop; and (3) TAU and IPS. For each intervention, we simulated three different outcome scenarios based on 100 patients. Results: Assuming a 40% employment rate and full-time employment (100%) for 10 years following IPS, we found a 10-year socioeconomic effect of €18,732,146. The corresponding effect for the more conservative TAU + IPS simulation assuming 40% part-time positions (25%) for five years, was €2,519,906. Compared to the two alternative interventions, IPS was cost-effective and more beneficial after six months to two years. Discussion: This concept evaluation study suggests that integrating employment support in the health services is socioeconomically beneficial. Our finding is relevant for decision makers within politics and health. Once employment rates from our ongoing RCT is available, real-life data will be applied to adjust model assumptions and socioeconomic value assumptions.
Støme, Linn Nathalie; Wilhelmsen, Christian R. & Kvaerner, Kari Jorunn (2021)
Enabling guidelines for the adoption of eHealth solutions: Scoping review
Objective This study aimed to explore the short- and long-term effects of a second cochlear implant (CI-2) on the reduction of tinnitus annoyance and tinnitus handicap. Design In a combined retrospective and prospective cohort study, tinnitus annoyance was measured before receiving the CI-2 (Pre), more than two years after (Post1) and more than seven years after (Post2), using the Tinnitus Handicap Inventory (THI), the Visual Analog Scale for the assessment of perceived tinnitus loudness (VAS-L) and annoyance (VAS-A), and a self-report questionnaire. Study sample Twenty sequentially bilaterally implanted adults with bothersome tinnitus. Results CI-2 implantation resulted in a statistically significant reduction of tinnitus handicap from severe at Pre to mild at Post1 (THI mean score reduced from 61.3 [SD = 19.4] to 29.3 [SD = 23.5]). The reduction in tinnitus annoyance was statistically significant from Pre to Post 2 (VAS-A reduced from 7.1 [SD = 1.5] to 3.4 [SD = 2.2]). The reduction in tinnitus loudness was not statistically significant. Conclusions The provision of a CI-2 for severely and profoundly hearing-impaired individuals with bothersome tinnitus is an effective method of providing long-term tinnitus relief.
Kværner, Kari Jorunn; Støme, Linn Nathalie, Romm, Jonathan, Rygh, Karianne, Almqvist, Frida, Tornås, Sveinung & Berg, Marianne Støren (2020)
Coassessment framework to identify person-centred unmet needs in stroke rehabilitation: a case report in Norway
Objective To describe unmet needs and values in stroke rehabilitation using the Health Value Framework and the associated coassessment tool Health Value Spider, a framework designed to identify and prioritise unmet needs based on health technology assessment (HTA). Setting The study took place at Oslo University Hospital, Norway, from February to April 2019. Participants in three consecutive workshops were recruited from Sunnaas Rehabilitation Hospital, Oslo Municipality, Hospital Procurement Trust and Oslo University Hospital. Twenty-four hospital workers (medical and allied health staff and administrative staff) participated in workshop 1 and 29 patients, user representatives and hospital workers in workshop 2. Twenty-one patients and hospital workers participated in workshop 3. Interventions Stakeholder analysis and scenario building was performed in a coassessment setting where unmet needs were identified applying the Health Value Framework. Two of the authors are also the developers of the Health Value Framework (KJK and LNS). Results In the two first workshops where health workers, patients and next of kin perspectives were elicited, three needs were identified: patient insecurity in patient journey transitions, lack of stroke rehabilitation expertise in primary care and invisible patient problems, such as fatigue and cognitive impairment. In workshop 3, 12 opportunity areas were identified. Four opportunity areas were selected by the stakeholders based on a prioritisation process: early discovery of cognitive impairment, rehabilitation continuity, empowered patients and next of kin and remote monitoring and digital touchpoints. Conclusion Health Value Spider successfully identified and prioritised unmet needs and described associated values.
Early health technology assessment (HTA), which includes all methods used to inform industry and other stakeholders about the potential value of new medical products in development, including methods to quantify and manage uncertainty, has seen many applications in recent years. However, it is still unclear how such early value assessments can be integrated into the technology innovation process. This commentary contributes to the discussion on the purposes early HTA can serve. Similarities and differences in the perspectives of five stakeholders (i.e., the hospital, the patient, the assessor, the medical device industry, and the policy maker) on the purpose, value, and potential challenges of early HTA are described. All five stakeholders agreed that integrating early HTA in the innovation process has the possibility to shape and refine an innovation, and inform research and development decisions. The early assessment, using a variety of methodologies, can provide insights that are relevant for all stakeholders but several challenges, for example, feasibility and responsibility, need to be addressed before early HTA can become standard practice. For early evaluations to be successful, all relevant stakeholders including patients need to be involved. Also, nimble, flexible assessment methods are needed that fit the dynamics of medical technology. Best practices should be shared to optimize both the innovation process and the methods to perform an early value assessment.
Støme, Linn Nathalie; Moger, Tron Anders, Kidholm, Kristian & Kvaerner, Kari Jorunn (2020)
A Web-based Communication Platform to Improve Home Care Services in Norway (DigiHelse): Pilot Study
JMIR Formative Research, 4:e14780(1), s. 1- 11. Doi: 10.2196/14780
Støme, Linn Nathalie; Moger, Tron Anders, Kidholm, Kristian & Kvaerner, Kari Jorunn (2019)
Early assessment of innovation in a healthcare setting
Kvaerner, Kari Jorunn & Støme, Linn Nathalie (2018)
NoTeB: Nordic co-creation of decision support tool for Healthcare innovation.
Finish Journal of ehealth and ewelfare
Støme, Linn Nathalie; Pripp, Are Hugo, Kværner, Jens Sørlie & Kvaerner, Kari Jorunn (2018)
Acceptability, usability and utility of a personalized application in promoting behavioral change in osteoarthritis patients: A feasibility study in Norway.
Background Most oral antibiotics are prescribed by GPs, and they are therefore the most important influencers with regard to improving antibiotic prescription patterns. Although GPs’ prescription patterns in general are well-studied, little is known about antibiotic prescription patterns in pregnancy. Aim To study GPs’ antibiotic prescriptions in respiratory tract infections (RTIs) during pregnancy, and assess differences, if any, between pregnant and non-pregnant patients. Design & setting Retrospective observational study combining prescription data from the Norwegian Peer Academic Detailing (Rx-PAD) study database, pregnancy data from the Norwegian birth registry, and pharmacy dispension data from the Norwegian Prescription Database (NorPD). Method Records of patient contacts with 458 GPs, between December 2004 and February 2007, were screened for RTI episodes. Similar diagnoses were grouped together, as were similar antibiotics. Episodes were categorised according to whether the patient was pregnant or not, and included women aged 16–46 years. Logistic regression models were used to assess odds ratios (ORs), and calculated relative risks (cRRs) were produced. The authors also adjusted for clustering at various levels. Results Overall prescription rate for RTI episodes was 30.8% (n = 96 830). The cohort was reduced to include only episodes with women pregnant in the study period (n = 18 890). The antibiotic prescription rate in pregnancy was 25.9% versus 34.2% in the time before and after pregnancy (cRR = 0.66 [95% confidence intervals {CI} = 0.68 to 0.81]). During pregnancy, 83.0% of the antibiotic prescriptions were picked up at a pharmacy, compared to an 86.6% filling rate in non-pregnant patients. The difference was not significant when adjusting for clustering at the patient level. Conclusion Norwegian GPs prescribe fewer antibiotics overall when patients are pregnant and, when they do prescribe, choose more narrow spectrum antibiotics for RTIs. This indicates a possible lower target rate for GP prescriptions to females. A low antibiotic dispension rate during pregnancy may represent a discussion topic in the consultation setting, to address possible reasons and avoid under-treatment.
Solheim, Jorunn; Gay, Caryl, Lerdal, Anners, Hickson, Louise & Kvaerner, Kari Jorunn (2018)
An evaluation of motivational interviewing for increasing hearing aid use: A pilot study
Journal of american academy of audiology, 29(8), s. 696- 705. Doi: 10.3766/jaaa.16184
Background: Noncommunicable diseases (NCDs) account for 70% of all deaths in a year globally. The four main NCDs are cardiovascular diseases, cancers, chronic pulmonary diseases, and diabetes mellitus. Fifty percent of persons with NCD do not adhere to prescribed treatment; in fact, adherence to lifestyle interventions is especially considered as a major challenge. Smartphone apps permit structured monitoring of health parameters, as well as the opportunity to receive feedback. Objective: The aim of this study was to review and assess the effectiveness of app-based interventions, lasting at least 3 months, to promote lifestyle changes in patients with NCDs. Methods: In February 2017, a literature search in five databases (EMBASE, MEDLINE, CINAHL, Academic Research Premier, and Cochrane Reviews and Trials) was conducted. Inclusion criteria was quantitative study designs including randomized and nonrandomized controlled trials that included patients aged 18 years and older diagnosed with any of the four main NCDs. Lifestyle outcomes were physical activity, physical fitness, modification of dietary habits, and quality of life. All included studies were assessed for risk of bias using the Cochrane Collaboration`s risk of bias tool. Meta-analyses were conducted for one of the outcomes (glycated hemoglobin, HbA1c) by using the estimate of effect of mean post treatment with SD or CI. Heterogeneity was tested using the I2 test. All studies included in the meta-analyses were graded. Results: Of the 1588 records examined, 9 met the predefined criteria. Seven studies included diabetes patients only, one study included heart patients only, and another study included both diabetes and heart patients. Statistical significant effect was shown in HbA1c in 5 of 8 studies, as well in body weight in one of 5 studies and in waist circumference in one of 3 studies evaluating these outcomes. Seven of the included studies were included in the meta-analyses and demonstrated significantly overall effect on HbA1c on a short term (3-6 months; P=.02) with low heterogeneity (I2=41%). In the long term (10-12 months), the overall effect on HbA1c was statistical significant (P=.009) and without heterogeneity (I2=0%). The quality of evidence according to Grading of Recommendations Assessment, Development and Evaluation was low for short term and moderate for long term.
Hoholm, Thomas; Strønen, Fred H., Kvaerner, Kari Jorunn & Støme, Linn Nathalie (2018)
Developing Organizational Amidexterity: Enabling Service Innovation in a Hospital Setting
Hoholm, Thomas; La Rocca, Antonella & Aanestad, Margunn (red.). Controversies in Healthcare Innovation. Service, Technology and Organization
In Chapter 13, Hoholm et al. discuss controversies in the healthcare sector by studying the nature of innovation projects at the Clinic of Innovation at Oslo University Hospital and its efforts to improve organizational ambidexterity in the area of service innovation. This includes more room for exploration, and improving their capacity to translate and exploit service innovations in use. Using the notions of ‘exploration’ and ‘exploitation’ (March, Organization Science 2:71–87,1991) the authors show how successful innovation requires two different organizational capacities and discuss how a complex knowledge organization like a hospital may increase its ability to handle both, often referred to as ‘organizational ambidexterity’ (Junni et al., The Academy of Management Perspectives 27:299–312, 2013). The authors propose three conditions for driving ambidexterity: organizational responsibilities and roles, provisional evaluation methods, and systematic cross-case learning.
Homøe, Preben; Kvaerner, Kari Jorunn, Casey, Janet R., Damoiseaux, Roger A.M.J., van Dongen, Thijs M.A., Gunasekera, Hasantha, Jensen, Ramon G., Kvestad, Ellen, Morris, Peter S. & Weinreich, Heather M. (2017)
Hoffman, Howard J.; Daly, Kathleen A., Bainbridge, Kathleen E., Casselbrant, Margaretha L., Homøe, Preben, Kvestad, Ellen, Kvaerner, Kari Jorunn & Vernacchio, Louis (2013)
Panel 1: Epidemiology, Natural History, and Risk Factors
Are children carrying the burden of broad-spectrum antibiotics in general practice? Prescription pattern for paediatric outpatients with respiratory tract infections in Norway
Background: A seven valent pneumococcal conjugate vaccine (PCV7) was introduced in the Norwegian childhood immunization programme in 2006, and since then the incidence of invasive pneumococcal disease has declined substantially. Recently, two new second generation pneumococcal conjugate vaccines have become available, and an update of the economic evidence is needed. The aim of this study was to estimate incremental costs, health effects and cost-effectiveness of the pneumococcal conjugate vaccines PCV7, PCV13 and PHiD-CV in Norway. Methods: We used a Markov model to estimate costs and epidemiological burden of pneumococcal- and NTHi-related diseases (invasive pneumococcal disease (IPD), Community Acquired Pneumonia (CAP) and acute otitis media (AOM)) for a specific birth cohort. Using the most relevant evidence and assumptions for a Norwegian setting, we calculated incremental costs, health effects and cost-effectiveness for different vaccination strategies. In addition we performed sensitivity analyses for key parameters, tested key assumptions in scenario analyses and explored overall model uncertainty using probabilistic sensitivity analysis. Results: The model predicts that both PCV13 and PHiD-CV provide more health gains at a lower cost than PCV7. Differences in health gains between the two second generation vaccines are small for invasive pneumococcal disease but larger for acute otitis media and myringotomy procedures. Consequently, PHiD-CV saves more disease treatment costs and indirect costs than PCV13. Conclusion: This study predicts that, compared to PVC13, PHiD-CV entails lower costs and greater benefits if the latter is measured in terms of quality adjusted life years. PVC13 entails more life years gained than PHiD-CV, but those come at a cost of NOK 3.1 million (∼D 0.4 million) per life year. The results indicate that PHiD-CV is cost-effective compared to PCV13 in the Norwegian setting.
Kristiansen, Håvard Anton; Kvaerner, Kari Jorunn, Akre, Harriet, Øverland, Britt & Russell, Michael Bjørn (2011)
Tension-type headache and sleep apnea in the general population
Tjerbo, Trond; Botten, Grete Synøve, Aasland, Olaf Gjerløw & Kværner, Kari Jorunn (2005)
Bruk av incentiver for å øke svarandelen i spørreskjemaundersøkelser
Tidsskrift for Den norske legeforening
Kværner, Kari Jorunn; Tjerbo, Trond, Botten, Grete Synøve & Aasland, Olaf Gjerløw (2005)
Epikrisen som samhandlingsverktøy
Tidsskrift for Den norske legeforening
Kvestad, Ellen; Kværner, Kari Jorunn, Røysamb, Espen, Tambs, Kristian, Harris, Jennifer R. & Magnus, Per (2005)
Heritability of recurrent tonsillitis
Archives of Otolaryngology - Head & Neck Surgery, 131, s. 383- 387.
Kværner, Kari Jorunn (2005)
Fastlegers oppfatning av samarbeidet med sykehjem
Tidsskrift for Den norske legeforening, 125, s. 1016- 1017.
Daly, KA; Rovers, MM, Hoffman, HJ, Casselbrant, ML, Zielhuis, G & Kværner, Kari Jorunn (2005)
Recent advances in otitis media. 1. Epidemiology, natural history, and risk factors
Annals of Otology, Rhinology and Laryngology, 194, s. 8- 15.
Kvestad, Ellen; Kværner, Kari Jorunn, Røysamb, Espen, Tambs, Kristian, Harris, Jennifer & Magnus, Per (2005)
Heritability of recurrent tonsillitis
Archives of Otolaryngology - Head & Neck Surgery, s. 383- 387.
Kvestad, Ellen; Kværner, Kari Jorunn, Røysamb, Espen, Tambs, Kristian, Harris, Jennifer R. & Magnus, Per (2004)
Otitis media: Genetic factors and sex differences
Twin research, 7, s. 239- 244.
Lindbæk, Morten & Kværner, Kari Jorunn (2004)
Behandling av akutt otitis media hos barn
Tidsskrift for Den norske legeforening
Ørebetennelse er den vanligste årsak til legebesøk og forskrivning av antibiotika. Akutt otitis media hos ellers friske barn skal ikke behandles med slike medikamenter, men barn med residiverende otitt skal få antibiotika på liberal indikasjon. Slike «ørebarn» trenger spesiell oppfølging. Hvis barnet har hatt sekretorisk otitt i mer enn tre måneder, skal det henvises til øre-nese-hals-spesialist.
Øverland, B; Akre, H, Kværner, Kari Jorunn & Skatvedt, O (2004)
Patient discomfort in polysomnography with esophageal pressure measurements
European Archives of Oto-Rhino-Laryngology
Kværner, Kari Jorunn (2004)
Tankevekkende tilpasning av øre-nese-hals-kirurgi
Tidsskrift for Den norske legeforening
Kvestad, Ellen; Kværner, Kari Jorunn, Røysamb, Espen, Tambs, Kristian, Harris, Jennifer & Magnus, Per (2004)