Policy responses for Sweden - HSRM

Sweden


Policy responses for Sweden

3.3 Maintaining essential services

On April 20th, the National Board of Health and Welfare presented principles for prioritizing resources for routine health care during the COVID-19 pandemic. The agency emphasizes to only delay care while the COVID-19 pandemic is in progress. According to the document, there are three possible ways to reduce care when available resources are exceeded: (i) give less of or stop completely with a treatment; (ii) change the threshold for medical indications such that patients will only be treated if they are presenting with more severe health conditions; (iii) postpone treatment. A model was presented showing the hierarchy of five prioritizing groups. According to the model, reduction of health care should start with care for patients whose health conditions (or the ability to treat the health condition) will not deteriorate.

Non-COVID-19 related health care services have been largely affected by the outbreak. Several counties have decided to postpone elective health care in order to enable resources for the treatment of patients with COVID-19. From March 30th to April 5th the number of elective surgeries in Sweden decreased by 63% compared to the average weekly number of elective surgeries from January 13th to February 9th. In the county of Sörmland, the number of elective surgeries decreased by 86%.

There are indications that the number of patients seeking non-COVID-19 related emergency care has decreased since the outbreak. For example, registration of patients with suspected myocardial infarction have decreased by around 25% since the outbreak in Sweden. The National Board of Health and Welfare and several counties are encouraging people to not hesitate to seek emergency care for urgent conditions. The National Board of Health and Welfare has issued guidance to primary care providers stating the importance of introducing triage to separate suspected COVID-19 cases from other patients. In some counties, all drop-in visits in primary care have been cancelled.

Digital visits for primary care were already available for all residents in Sweden, but as a consequence of COVID-19, more and more health care providers are offering remote consultations by expanding their existing digital platforms (telemedicine). For example, in the county of Jönköping, about 1 000 employees in the region's 33 primary care centres will be trained to use a digital platform in just over a week. Another example of regional action to stimulate remote consultations is that some counties have abolished restrictions on how many of these health care providers are allowed to provide in a year.

Sources:
https://www.socialstyrelsen.se/globalassets/sharepoint-dokument/dokument-webb/ovrigt/nationella-principer-for-prioritering-av-rutinsjukvard-covid19.pdf
https://www.svt.se/datajournalistik/corona-uteblivna-operationer/ 
https://www.skane.se/organisation-politik/Nyheter/Halsa-och-vard/2020/covid-19-information-om-aterhallsamhet-med-planerad-vard-och-forlossning-med-kejsarsnitt/
https://www.sll.se/verksamhet/halsa-och-vard/nyheter-halsa-och-vard/2020/03/planerad-vard-skjuts-upp-och-sjukvardspersonal-gors-tillganglig/
https://www.svt.se/nyheter/lokalt/ost/regionens-uppmaning-tveka-inte-att-soka-vard 
https://www.dagensmedicin.se/artiklar/2020/03/30/farre-patienter-soker-vard-for-akut-kranskarlssjukdom/
https://www.dagensmedicin.se/artiklar/2020/03/27/webbokning-gav-lugn-i-vantrummet/
https://vgrfokus.se/2020/04/uppmaningen-boka-inte-av-ditt-vardbesok/
https://www.socialstyrelsen.se/globalassets/sharepoint-dokument/dokument-webb/ovrigt/triage-arbetssatt-vardcentral-covid19.pdf
https://www.socialstyrelsen.se/aktuellt/viktigt-att-vaga-soka-vard-vid-akuta-symtom/