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  • Closed Access Danish
    Authors: 
    Ehlers, Lars Holger;
    Country: Denmark

    Debat: Vi har afsat 4 milliarder til COVID-19 uden en strategi for, hvordan vi får mest for pengeneNår der skal indkøbes for hurtigt på politikernes anvisninger, er der større risiko for fejl, og der bliver ikke altid kanaliseret tilstrækkelige ressourcer, tid og ledelsesfokus til at optimere den offentlige indkøbsproces. Så hermed en opfordring: Afsæt en del af de 4 milliarder kroner til forebyggende indkøbsarbejde og samarbejde med industrien, skriver sundhedsøkonom Lars Holger Ehlers i debatindlæg.Lars Holger Ehlers 22/09/2021Del:FacebookTwitterLinkedInEmailVigtigheden af at prioritere innovation i den offentlige indkøbsforretning er en aktuel problemstilling både herhjemme og i udlandet. En stor undersøgelse foretaget af EU Kommissionen konkluderede således allerede i 2013, at risiko for fejl, korruption, in-effektivitet og for høje indkøbspriser var et stort problem i sundhedsvæsenet i alle EU-lande. Indkøbsområdet bør gives flere administrative ressourcer, længere tid til at forberede indkøb, og samarbejde med industrien bør generelt have større ledelsesfokus.Herhjemme taler og skriver man ikke meget om offentlige indkøb, medmindre pressen pludselig får kendskab til en sag om misbrug af offentlige midler eller manglende levering af serviceydelser. Omvendt omtales godt offentligt indkøbsarbejde stort set aldrig, og det giver sjældent ekstra i lønposen hos den offentlige indkøber.Betydningen af et godt samarbejde mellem industri og offentlige forhandlere blev ellers for alvor illustreret ved forkøbsaftalerne om udvikling og markedsføring af COVID-19 vacciner. Uden disse kontrakter (og det store bagvedliggende bureaukratiske arbejde) var der næppe skabt de samme incitamenter i industrien til at opprioritere forskningen, og verdenssamfundet havde ikke fået vaccinerne lige så hurtigt på markedet.Senere blev kontrakterne desuden udskældt, da leveringssikkerheden ikke var tilstrækkeligt forhandlet på plads fra begyndelsen. Begge episoder er eklatante eksempler på, hvordan den offentlige indkøbsforretning kan have kæmpe betydning for samfundet både positivt og negativt.Gode modeller sparer store beløbInnovative indkøbsmodeller kan, alt afhængig af omstændighederne, konstrueres på forskellig vis. Medicinrådets samarbejde med kliniske specialister og offentlige indkøbere i Amgros er et konkret eksempel, hvor der er sparet millioner af kroner gennem udvikling af en innovativ model for analog konkurrence.Kontrakterne på ambulanceområdet er et andet eksempel, hvor de seneste udbudsrunder har givet mange millioner kroner i årlige besparelser, fordi opgavedelingen er optimeret, og kompetencerne til at gennemføre udbud og kontraktindgåelse i det offentlige er forbedret.På det seneste er det også lykkedes med flere innovative købsmodeller i offentligt-private-samarbejde, så danske patienter kan få adgang til meget dyr medicin til behandling af sjældne sygdomme. Medicin, som vi ellers ikke ville have råd til. De midler, som er sparet igennem innovative offentlige indkøbsforretninger, gives ikke tilbage til skatteyderne, men giver til gengæld mulighed for indkøb af flere andre ydelser til borgerne.Kendetegnende for de ’gode’ eksempler er tid, prioritering og ledelsesfokus i det offentlige sundhedsvæsen. Når disse omstændigheder er gældende, har vi i Danmark et sundhedsvæsen, som langt hen ad vejen er i stand til at maksimere værdien per skattekrone uden hverken korruption eller problemer med forringet kvalitet, unødige forsinkelser eller meget høje indkøbspriser.Har vi intet lært?Men det kan også gå rygende galt, når det offentlige sundhedsvæsen skal handle for hurtigt efter politikernes anvisninger.I det forgangne år har vi desværre set alt for mange eksempler på dette i forbindelse med coronakrisen og udmøntningen af ’krigskassen’, som sidste år blev afsat til corona-bekæmpelsen.Der har været historier i pressen om overnormal profit hos private leverandører, som drev corona-relaterede aktiviteter på vegne af det offentlige. Vi har set kontrakter med skandaleramt virksomhed, som medførte kvalitetsproblemer og et retsligt efterspil. Og den seneste historie i pressen om varetagelse af fritvalgsordningen, hvor et privat firma har fået en betaling fra det offentlige svarende til en pris per vaccination på 5.000 kroner, er blevet betegnet som “fuldstændig urimelig brug af skatteydernes penge”. Vi har set eksempler på forsyningsproblemer og alt for mange sager i pressen, som har svækket befolkningens tillid til den offentlige forvaltning. Og hvad har vi lært af dette?Læser man finanslovsudspillet, har vi tilsyneladende intet lært. Der afsættes fire milliarder kroner, som kun skal bruges, hvis vi får behov for det. Det er en pulje reserveret til ”krigsførelse”, der i lighed med scenariet på seneste finanslov, kan aktiveres ved behov for at sikre handlerum til at håndtere udfordringer som følge af COVID-19.Det ligner med andre ord en gentagelse af opskriften på endnu en gang at risikere dårligt offentligt købmandsskab. Når der skal indkøbes for hurtigt på politikernes anvisninger, er der større risiko for fejl, og der bliver ikke altid kanaliseret tilstrækkelige ressourcer, tid og ledelsesfokus til at optimere den offentlige indkøbsproces.Afsæt penge til forebyggende procesSå hermed en opfordring: Afsæt en del af de 4 milliarder kroner til forebyggende indkøbsarbejde og samarbejde med industrien. Nedsæt en ekspertgruppe, som skal indsamle erfaringer på godt og dårligt samarbejde mellem industri og sundhedsvæsen fra de seneste 2 år. Lav forarbejdet til konkurrenceudsættelse af forskellige typer af opgaver i et pandemiberedskab, udarbejd skuffekontrakter på forskellige typer af opgaver, indgå i dialog og samarbejde med private virksomheder om muligheder for hurtig løsning af potentielle opgaver. Brug en del af midlerne til at udmønte life science-strategiens ønsker om innovative aftaler.Der er et stort behov for at oparbejde erfaring i det offentlige sundhedsvæsen med innovative indkøbsmodeller, som senere kan komme både industrien, sundhedsvæsenet og patienterne til gode. Det gælder eksempelvis områder som sjældne sygdomme og antibiotika, hvor der er behov for flere af sådanne modeller.Mit gæt vil være, at der i sidste ende både er mange millioner og et forbedret serviceniveau at hente ved at undgå endnu et år med eksempler på forhastede indkøbsaftaler. Der er mulighed for at undgå de samme problemer igen og sprede de gode erfaringer til et endnu bedre fremtidigt offentlig-privat samarbejde.

  • Closed Access
    Authors: 
    Louise Redder; Sören Möller; Mary Ellen Jarden; Cl, Andersen; Henrik Frederiksen; Henrik Gregersen; Anja Klostergaard; Morten Saaby Steffensen; Per Trøllund Pedersen; Maja Hinge; +6 more
    Country: Denmark
  • Closed Access English
    Authors: 
    Glintborg, B.; Jensen, D. V.; Engel, S.; Terslev, L.; Jensen, M. Pfeiffer; Hendricks, O.; Ostergaard, M.; Rasmussen, S. H.; Adelsten, T.; Danebod, K.; +11 more
    Country: Denmark
  • Closed Access
    Authors: 
    Nygaard, Ulrikka; Holm, Mette; Dungu, Kia Hee Schultz; Matthesen, Astrid Thaarup; Stensballe, Lone Graff; Espenhain, Laura; Hartling, Ulla;
    Publisher: American Academy of Pediatrics (AAP)
    Country: Denmark

    Myopericarditis is a severe adverse event to COVID-19 vaccines.1 The highest risk has been reported in males aged 12-29 years.2-4 According to the US Vaccine Adverse Event Reporting System (VAERS), the risk in children aged 5-11 years is low with 11 reported cases following 8.7 million doses of Pfizer-BioNTech vaccine.5 However, these numbers may be underestimated due to underreporting.6.

  • Closed Access English
    Authors: 
    Emma Heeno; Irmelin Biesenbach; Charlotte Englund; Martin Lund; Anja Toft; Lars Lund;
    Country: Denmark

    Objective: In March-April 2020, during the coronavirus disease 2019 (COVID-19) pandemic lockdown in Denmark, the Danish Health Authorities recommended that, where possible, face-to-face patient-physician consultations be replaced by telephone consultations. The aim of this study was to obtain patients’ evaluation of their telemedicine experience. Methods: Patients who were candidates for telemedicine consultations were recruited based on their urological ailment, necessity for follow-up and comorbidity. New referrals including patients with suspicion of cancer were not candidates for telemedicine. In total, 548 patients had their appointment altered during the period from 13 March to 30 April 2020. Postal questionnaires were sent to 548 patients and 300 (54.7%) replied. Results: In total, 280 patient answered, 224 (80%) men and 56 (20%) women, mean age 69 years (range 18–91) of whom 180 (64.3%) had a benign and 100 (35.7%) a malignant diagnosis. Twenty (6.7%) respondents did not remember their telephone consultation and were therefore excluded. Telephone consultation satisfaction was reported by 230 (85.0%) patients, but they would not prefer video consultations over telephone consultations, and only 102 (36.4%) would prefer telephone consultations in the future. Patients’ age, sex and distance to the hospital did not seem to be associated with telephone consultation satisfaction (age p = 0.17; sex p = 0.99; distance p = 0.27, respectively). In total, 226 (80.7%) were medically assessed as being at risk for COVID, but 74 (26.4%) subjectively evaluated themselves as being at risk. Conclusions: In general (85.0%), urological patients were satisfied with telephone consultations.

  • Closed Access English
    Authors: 
    Adit A. Ginde; Roger Paredes; Thomas A. Murray; Nicole Engen; Greg Grandits; Andrew Vekstein; Noel Ivey; Ahmad Mourad; Uriel Sandkovsky; Robert L. Gottlieb; +91 more
    Country: Denmark

    BACKGROUND: Tixagevimab-cilgavimab is a neutralising monoclonal antibody combination hypothesised to improve outcomes for patients hospitalised with COVID-19. We aimed to compare tixagevimab-cilgavimab versus placebo, in patients receiving remdesivir and other standard care.METHODS: In a randomised, double-blind, phase 3, placebo-controlled trial, adults with symptoms for up to 12 days and hospitalised for COVID-19 at 81 sites in the USA, Europe, Uganda, and Singapore were randomly assigned in a 1:1 ratio to receive intravenous tixagevimab 300 mg-cilgavimab 300 mg or placebo, in addition to remdesivir and other standard care. Patients were excluded if they had acute organ failure including receipt of invasive mechanical ventilation, extracorporeal membrane oxygenation, vasopressor therapy, mechanical circulatory support, or new renal replacement therapy. The study drug was prepared by an unmasked pharmacist; study participants, site study staff, investigators, and clinical providers were masked to study assignment. The primary outcome was time to sustained recovery up to day 90, defined as 14 consecutive days at home after hospital discharge, with co-primary analyses for the full cohort and for participants who were neutralising antibody-negative at baseline. Efficacy and safety analyses were done in the modified intention-to-treat population, defined as participants who received a complete or partial infusion of tixagevimab-cilgavimab or placebo. This study is registered with ClinicalTrials.gov, NCT04501978 and the participant follow-up is ongoing.FINDINGS: From Feb 10 to Sept 30, 2021, 1455 patients were randomly assigned and 1417 in the primary modified intention-to-treat population were infused with tixagevimab-cilgavimab (n=710) or placebo (n=707). The estimated cumulative incidence of sustained recovery was 89% for tixagevimab-cilgavimab and 86% for placebo group participants at day 90 in the full cohort (recovery rate ratio [RRR] 1·08 [95% CI 0·97-1·20]; p=0·21). Results were similar in the seronegative subgroup (RRR 1·14 [0·97-1·34]; p=0·13). Mortality was lower in the tixagevimab-cilgavimab group (61 [9%]) versus placebo group (86 [12%]; hazard ratio [HR] 0·70 [95% CI 0·50-0·97]; p=0·032). The composite safety outcome occurred in 178 (25%) tixagevimab-cilgavimab and 212 (30%) placebo group participants (HR 0·83 [0·68-1·01]; p=0·059). Serious adverse events occurred in 34 (5%) participants in the tixagevimab-cilgavimab group and 38 (5%) in the placebo group.INTERPRETATION: Among patients hospitalised with COVID-19 receiving remdesivir and other standard care, tixagevimab-cilgavimab did not improve the primary outcome of time to sustained recovery but was safe and mortality was lower.FUNDING: US National Institutes of Health (NIH) and Operation Warp Speed.

  • Closed Access English
    Authors: 
    Alison Louise Milner; Paola Mattei; Christian Ydesen;
    Country: Denmark

    Strategic government interventions in public education have shifted and blurred the boundaries between state, market and civil society modes of governance. Within this matrix of interdependent relations, schools operate under increasingly hybrid accountability arrangements in which public accountability can both complement and compete with market and social regimes and their associated institutional logics, goals, values and mechanisms. During the first wave of the COVID-19 pandemic, however, national governments implemented a wide range of emergency measures which had consequences for the mixes and layers of school accountabilities. This article examines the principal policy changes in Denmark, England and Italy. Drawing on state theories and the concept of ‘hybrid accountability’, semi-structured interviews with national and local policymakers and school practitioners were analysed thematically. While cultural nuances exist between the cases, our findings reveal that state interventions reinforce a public–professional accountability hybrid and hierarchies of control and command within and outside networks. Concomitantly, state non-interventions and the distinct underlying institutional logics associated with national large-scale assessments suggest policy inertia with implications for professional accountability and institutionalised change. Future research might investigate whether educators’ experiences influence the direction of national and local accountability policy reforms in a post-pandemic era.

  • Closed Access English
    Authors: 
    Michael Dalager-Pedersen;
    Country: Denmark
  • Closed Access Danish
    Authors: 
    Stripp, Tobias Kvist; Søndergaard, Jens;
    Country: Denmark

    During the SARS-CoV-2 pandemic, testing of suspected cases in Denmark has recently been limited to those who were critically ill. This has left an increasing number of unregistered infections in the society, obscured quantification and impacted lived lives. This case story reports a possible mild SARS-CoV-2 infection in a healthy young man in his twenties. Due to strategic guidelines, he was never tested for SARS-CoV-2, but the medical record was highly suspicious for infection. Besides the well-known symptoms of SARS-CoV-2, this case also reports total anosmia and ageusia.

  • Closed Access English
    Authors: 
    Nielsen, Rikke Kristine; Cheal, Joe; Pradies, Camille;
    Country: Denmark

    The communication from leaders during a time of crisis significantly impacts how the crisis unfolds. Leaders also play a decisive role in fostering either virtuous or vicious dynamics when organizations are torn between competing demands(Pradies et al., 2020; Smith, 2014). But never has it been morepressing for organizational leaders to be mindful of what andhow they communicate than in the COVID-19 crisis. In manycases, the current pandemic has surfaced the “invisible currents of paradox” (Quinn & Nujella, 2017, p. vii) operating within organizations, making it vital for leaders to craft messages that align people’s beliefs and actions and mobilize them towards a common goal.