Date: 2020-06-05 Level: Bachelor thesis in Business Administration, 15 cr Institution: School of Business, Society and Engineering, Mälardalen University Authors: Lovisa Bodin (96/11/06), Jonna Lundin (97/12/05), Julia Öhrberg Nyberg (98/05/18) Title: Digitalization within the health care Tutor: David Freund Keywords: Health care centers, digital health care, primary care, digital health care services Research Questions: How does health centers get affected by the digital health care providers? How does the health centers relate to this impact organizationally? Purpose: The purpose with this study is to describe how digital health care providers affect health centers organizationally and investigate if and how health centers acts on the basis of the digital health care providers. Method: The study is based on a qualitative method with five semi-structured interviews which were processed through a thematic analysis. Conclusion: Health centers are affected financially, through extended competition and greater workload by digital health care providers. Therefore, health centers have adapted their way of working and, among other things, have started or discussed about offering other services that improve their accessibility to approach what characterizes the digital health care providers. Some health centers are adopting the same services that digital health care providers offer, while there are health centers that develops alternative services to improve their accessibility. / Datum: 2020-06-05 Nivå: Kandidatuppsats i företagsekonomi, 15 hp Institution: Akademin för Ekonomi, Samhälle och Teknik, Mälardalens högskola Författare: Lovisa Bodin (96/11/06), Jonna Lundin (97/12/05), Julia Öhrberg Nyberg (98/05/18) Titel: Digitalisering inom hälso- och sjukvården Handledare: David Freund Nyckelord: Vårdcentraler, digital vård, primärvård, digitala vårdtjänster Frågeställning: Hur påverkas vårdcentralerna av digitala vårdverksamheter? Hur förhåller sig vårdcentralerna organisatoriskt till den påverkan? Syfte: Syftet med den här uppsatsen är att beskriva hur digitala vårdverksamheter påverkar vårdcentraler organisatoriskt och undersöka om och i sådana fall hur vårdcentralerna agerar utifrån påverkan från de digitala vårdverksamheterna. Metod: Studien grundas på en kvalitativ metod där fem semi-strukturerade intervjuer genomförts som sedan behandlats genom en tematisk analys. Slutsats: Vårdcentraler påverkas ekonomiskt, via utökad konkurrens och större arbetsbelastning av de digitala vårdverksamheterna. Därför har vårdcentraler anpassat sitt arbetssätt och bland annat börjat eller fört diskussioner om att erbjuda andra tjänster som förbättrar deras tillgänglighet för att närma sig det som utmärker de digitala vårdverksamheterna. En del vårdcentraler tar efter de tjänster som digitala vårdverksamheter erbjuder medan det finns vårdcentraler som utvecklar alternativa tjänster för att förbättra tillgängligheten.

Hearing loss is considered a global health concern with 466 million people affected worldwide. Current hearing health care delivery models are based on several consecutive face-to-face consultations that occur in-person. Information and communications technology, and especially mobile technology, can be used to support or enhance health care delivery. This can be employed in addition, or as an alternative to, current patient treatment pathways. This project developed a hybrid hearing health care approach by combining online and face-to-face services. The services were offered using a five-step approach: (1) online hearing screening, (2) motivational engagement by voice/video calling, messaging, or emailing, (3) diagnostic hearing testing in a face-to-face appointment, (4) counseling, hearing aid trial and fitting using face-to-face and online methods, and (5) online aural rehabilitation, counseling and ongoing coaching using face-to-face and online methods. Three studies were conducted. Study I investigated the readiness, characteristics and behaviors of patients who sought hybrid hearing health care. Over three months (June–September 2017), 462 individuals completed the online hearing screening test: 59% (271/462) of those failed (age M = 60; SD = 12), indicating that further assessment and treatment might be required. These patients had been aware of their hearing loss for a period of between 5 to 16 years. A significant positive correlation was observed between age and speech reception threshold (r = 0.21; p < .001), where older participants presented with poorer scores. Five participants completed readiness measurement scales and attended a face-to-face diagnostic hearing evaluation during this time. Study II investigated patient uptake, experience and satisfaction with hybrid hearing health care using a process evaluation. The process evaluation study was conducted over a three-month period for patients who sought services from the clinic over a period of 19 months (June 2017–January 2019). A total of 46 patients seen at the clinic were invited to complete an online questionnaire regarding their experiences and satisfaction with the steps completed and services provided. Of those, 31 (67%) patients responded (age M = 66; SD = 16). Of the 61% of patients who had previously sought hearing services, 95% reported the hybrid clinic services as superior. Two main themes emerged from the patient’s comparison of their experience with the hybrid clinic versus previous experiences: clinician engagement (personal attention, patience, dedication, thorough explanations, professional behavior, exceeding expectations, friendliness and trust) and technology (latest technology, advanced equipment and hearing aid trial). Patients who completed all five steps, including acquiring hearing aids and taking part in an online aural rehabilitation program (continued with hearing health care), were significantly older and had significantly poorer speech reception thresholds compared to those who did not acquire hearing aids after the diagnostic hearing test and hearing aid trial (discontinued hearing health care). A significant positive correlation was found between age and the number of face-to-face appointments attended per patient (r = 0.37; p = .007). Study III investigated whether digital proficiency (proficiency with mobile devices and computers) was a predictor of the uptake of hybrid hearing health care. A total of 931 individuals failed the online hearing screening test and had submitted their details to the clinic for further care over a 24-month period (June 2017–June 2019). Of the 931 online test takers, 53 persons (age M = 64; SD = 15) who attended a face-to-face diagnostic hearing testing completed a mobile device and computer proficiency questionnaire. An exact regression model identified age as the factor associated with patients completing all five steps, including acquiring hearing aids and taking part in an online aural rehabilitation program (continued with hearing health care) from a hybrid model (β = .07; p = .018). Older patients were more likely to continue to seek hearing health care. Digital proficiency was not significantly associated with adults with hearing loss taking up services through a hybrid hearing health care model. The results from these three studies demonstrate that asynchronous internet-based services such as an online hearing screening test can be used to create awareness of hearing health care. It is possible to provide online support to patients during the initial stages of seeking hearing health care online prior to the first face-to-face visit. Patient uptake, satisfaction and experience of using hybrid hearing health care services are positive when compared to traditional methods of service delivery. Hearing health care models that combine face-to-face and online methods hold promise for audiologists willing to incorporate online modalities into current treatment pathways. This research project highlights the opportunity for audiologists to provide services and personalized support to patients using a combination of face-to-face and online modalities. / Thesis (PhD)--University of Pretoria, 2020. / This work was supported by the National Research Foundation (NRF) of South Africa under the grant number 107728. / Speech-Language Pathology and Audiology / PhD (Audiology) / Unrestricted

Bakgrund: Digitaliserad vård har utvecklats allt mer de senaste åren och ställer krav på sjuksköterskor att upprätthålla och utveckla kompetens i digitaliserad vård. Syfte: Att beskriva sjuksköterskors upplevelse av implementering och användande av digitaliserad vård i primärvården -ur ett psykosocialt arbetsmiljöperspektiv. Metod: En deskriptiv design med kvalitativ ansats användes för att besvara intervjustudiens syfte och frågeställningar. Studien baserades på 10 intervjuer med leg. sjuksköterskor och har analyserats med deduktivt arbetssätt utifrån Krav- kontroll och stödmodellen. Huvudresultat: Sjuksköterskor upplevde kvantitativa krav som tidsbrist, personalbrist och merarbete, emotionella krav som upplevelse av ojämlik vård samt en del kognitiva krav. Upplevelse av bristande kontroll var talande och utgjordes framför allt av känslor av toppstyrning, bristande möjlighet att påverka, bristande utbildningsmaterial, avsaknad av arbetssätt samt många avbrott i arbetet och oro för ökad vårdkonsumtion. Det sociala stödet var framför allt kollegialt. Slutsats: Digitala vårdtjänster kommer fortsatt utvecklas med syfte att effektivisera vården och möta ett ökat vårdbehov. Det är av vikt att ta hänsyn till hur sjuksköterskors arbetsmiljö påverkas av digitaliserad vård för att främja en god arbetsmiljö för sjuksköterskor och därigenom god omvårdnad mot patienter. Genom att ge sjuksköterskor möjlighet att påverka sina arbetssätt och utveckling av system kan digitaliserad vård utvecklas med sjuksköterskor. / Background: Digital health care has developed further more during recent years and creates demands on nurses to maintain and develop competence in digital health care. Aim: To describe nurses' experience of implementation and daily use of digital health care in primary care - from a psychosocial work environment perspective. Method: A descriptive design with a qualitative approach was used to respond to the aim and questions of the interview study. The study was based on 10 interviews with reg. nurses and has been analyzed using a deductive method linked to The job demand-control-support model. Main results: Nurses experienced quantitative demands such as lack of time, staff shortages and extra workload, emotional demands such as the experience of unequal care and some cognitive demands. The experience of  lack of control was extensive and consisted of feelings of top management, lack of opportunity to influence, insufficient education training materials, lack of working methods and many interruptions in work and concerns about increased healthcare consumption. The social support was primarily collegial. Conclusion: Digital care services will continue to be developed with the aim of making care more effective and facilitate increased care needs. It is important to take into consideration how nurses' work environment is affected by digitalized care in order to promote a good work environment for nurses and thereby good care for patients. By giving nurses the opportunity to influence their working methods and system development, digital healthcare can be developed with nurses.

Chronic diseases account for about 80\% of the total health care costs in Sweden, where the current health care system is designed according to the characteristics of acute diseases. Chronic care management is characterized by a long-term perspective and inclusion of multiple health care practitioners during the care process. New and more advanced digital health care solutions have emerged due to technology progress followed by increased use of consumer electronics. It creates opportunities to customize and advance health care services. Existing digital health care offerings include functions designed for acute symptoms, and single digital consultation sessions and treatments plans extending over a shorter period of time. There is a significant shortcoming of existing digital health care services for chronic patients, and research is lacking on how to construct such a service. The research was conducted with the digital health care provider Doktor24. The data for the study was both quantitatively and qualitatively collected through collection of existing statistical data and a patient survey, and interviews with patients and medical care personnel. Identified requirements indicate that asthma patients are not satisfied with the current physical asthma care process, where the process today is time-consuming and not particularly adjusted to benefit asthmatics. Patient preferences were summarized in three major aspects; accessibility and time efficiency, a dynamic customized treatment plan and independent self care. Determined functions were digital visits, digital spirometry, notifications and education and information. Together the functions form the basis for a digital chronic care solution for asthma patients. The thesis contributes to research by presenting a unique exploration on the existing opportunities with a patient-centric digital health care service for asthma patients. / Kroniska sjukdomar motsvarar idag ungefär 80% av totala sjukvårdskostnaderna i Sverige, där det nuvarande sjukvårdssystemet är utformat utifrån akuta sjukdomar. Kronisk vårdhantering karakteriseras av ett långsiktigt perspektiv, samt av flertalet involverade vårdaktörer. Nya och mer avancerade digitala sjukvårdslösningar har uppstått som ett resultat av teknologiska framsteg samt ett ökat användande av digitala hjälpmedel. Det skapar möjligheter att skräddarsy och utveckla sjukvårdstjänster. Existerande digitala erbjudanden inkluderar funktioner och lösningar för akuta symtom och sjukdomar, och enstaka digitala konsultationer samt behandlingsplaner som sträcker sig över en kortare tidsperiod. Det finns idag en tydlig brist i utbudet av digitala sjukvårdstjänster för kroniskt sjuka. Studien utfördes i samarbete med den digitala sjukvårdsaktören Doktor24. Datainsamlingen inkluderade både kvantitativ och kvalitativ data, bestående av existerande statistik och en patientundersökning, samt utförda intervjuer med patienter och vårdpersonal. Identifierade krav indikerar att astmapatienter inte är nöjda med den existerande fysiska sjukvårdsprocessen, då processen idag är tidskrävande och inte speciellt anpassad för astmatiker. Patientpreferenserna sammanfattades i tre aspekter; tillgänglighet och tidseffektivitet, en dynamiskt anpassad behandlingsplan samt utbildning och information. Tillsammans utgör funktionerna grunden för en digital kronisk sjukvårdstjänst för astmatiker. Studien bidrar till forskning genom att presentera en unik undersökning av existerande möjligheter med en patient-centrerad digital sjukvårdstjänst för astmatiker.