Coordinating care of the multimorbid elderly in Sweden – lessons learned from practice and research

Older patients face medical risks as coordination between municipalities and regions is failing. Clearer central government instructions regarding these types of collaborations are necessary, according to Paula Blomqvist and Ulrika Winblad in a new SNS report.

Elderly individuals requiring both regional and municipal health care services may result in situations in which no party takes overall responsibility. Despite years of seeking to improve this situation and despite the fact that these problems became particularly evident during the pandemic, this risk remains, write Paula Blomqvist and Ulrika Winblad in the SNS report “Coordinating care of the multimorbid elderly in Sweden – lessons learned from practice and research”. There has been an increase in terms of multimorbid elderly patients being readmitted to hospitals in an unplanned manner. And, the authors highlight, while there is a law on so-called coordinated individual planning (SIP), such coordination does not always materialize.

In addition to stress and anxiety, poor coordination also poses medical risks to patients. This also represents a socio-economic problem, as it often leads to an increased need for hospital care, says Paula Blomqvist, professor of political science.

In the report, the researchers examine Swedish experiences and international research in the field. They find that collaboration reforms may have positive effects, primarily in terms of patient satisfaction and accessibility. However, they also find that staff shortages appear to be one of the greatest obstacles to successful collaborations. While there is a need for more physicians in municipal activities, there are not enough general practitioners in the regions. There is also a shortage of nurses and other medical staff in municipal health care services.

Strengthening medical expertise in municipalities is crucial for ensuring that more elderly individuals receive help on time at the right level of care. We also see that primary care services do not have the necessary capacity to meet the health care needs of multimorbid older patients, according to Ulrika Winblad, professor of health services research.

Blomqvist and Winblad also want clearer central government instructions on collaborations between the various actors in health care. Legislation in this area states that they should collaborate but does not say anything about how. As a result, a number of local models have been developed that are difficult to survey and evaluate. In addition, the follow-up performed by government agencies and organizations is largely based on what is described as good examples. This leads to unclear instructions, according to the researchers of the report, who call for more exact guidelines.

About the authors

Paula Blomqvist is a professor of political science at Uppsala University.

Ulrika Winblad is a professor of health services research at Uppsala University.