Hilde Lurås

• Gyawali, Sanjay; Nakstad, Espen Rostrup; Sletvold, Bjørn; Lurås, Hilde; Wisløff, Torbjørn & Benth, Fred Espen [Show all 7 contributors for this article] (2026). Infection dynamics across regions during the COVID-19 pandemic in Norway. Journal of Infection and Public Health. ISSN 1876-0341. 19(9), p. 1–12. doi: 10.1016/j.jiph.2026.103328. Full text in Research Archive Show summary

  Background: Urban areas often act as early epicentres of pandemics, yet transmission dynamics across regions with different demographic profiles remains poorly understood. We aimed to characterise COVID-19 transmission in Norway and assess how it interacted with infection control measures across urban and rural settings. Methods: We analysed daily COVID-19 cases across three pandemic waves (Alpha, Delta, Omicron). For local trends, 36 sites in the Greater Oslo Region were grouped by infection trajectories using group-based trajectory modelling. For national trends, we examined the cities of Oslo, Bergen, Trondheim, Stavanger, Tromsø, and Akershus county. Infection trends were analysed using linear mixed models and lagged regression analyses and related to demographic characteristics. Results: In the Greater Oslo Region, three distinct site groups-high, moderate, and low infection-were identified. The high infection group had the highest population density, largest proportion of crowded housing and immigrant population and preceded the moderate and low groups by 5-13 days during the Alpha wave. Nationally, Oslo's infection rates peaked 11-24 days before other cities during the Alpha wave, with shorter lags during the Delta and Omicron waves. Despite similar control measures, infection rates differed substantially, with the high infection group and Oslo city consistently bearing the greatest burden. Conclusions: Densely populated areas with crowded housing act as early warning signals, with infection growth preceding that in other areas by days to weeks. Systematic monitoring of such high-burden urban areas could provide valuable lead time for policymakers and support more targeted, timely responses in future pandemics.

• Lium, Marius Aleksander; Rugkåsa, Jorun; Hofstad, Tore; Lurås, Hilde & Nyttingnes, Olav (2026). Temporal patterns in compulsory psychiatric admissions: a four-year, nationwide registry study from Norwegian acute wards. Nordic Journal of Psychiatry. ISSN 0803-9488. 80(4), p. 257–264. doi: 10.1080/08039488.2026.2670376. Full text in Research Archive
• Heupink, Lieke Fleur; Nakstad, Espen Rostrup; Lurås, Hilde; Wiik, Pål; Lippestad, Kristine & Benth, Fred Espen [Show all 7 contributors for this article] (2026). Short term forecast of new daily pandemic hospitalizations: A time series model for a single hospital. Epidemics. ISSN 1755-4365. 54. doi: 10.1016/j.epidem.2026.100894. Full text in Research Archive
• Ibsen, Tanja Louise; Zotcheva, Ekaterina; Bergh, Sverre; Gerritsen, Debby; Livingston, Gill & Lurås, Hilde [Show all 11 contributors for this article] (2025). Cognitive function, physical function, and mental health in older adults amid reduced primary and specialist healthcare service use during COVID-19: the HUNT study. GeroScience. ISSN 2509-2715. 48(2026)(3), p. 4313–4325. doi: 10.1007/s11357-025-01909-x. Full text in Research Archive Show summary

  Abstract COVID-19 containment measures reduced older adults’ healthcare access, with uncertain long-term effects on cognitive, physical, and mental health. To investigate whether reductions in primary and specialist healthcare service use during the pandemic were associated with changes in cognitive, physical, and mental health in community-dwelling older adults, with attention to sex differences. Data from the Norwegian Trøndelag Health Study collected before (HUNT4 70 + , 2017–2019) and after the pandemic (HUNT AiT, 2021–2023) included 5387 participants (53% women) aged 70 + . Propensity score matching, accounting for baseline confounders, was used to examine associations between reduced healthcare service use and cognitive, physical, and mental health changes from pre- to post-pandemic. Reduced contact with general practitioners was associated with greater cognitive decline among women (MoCa-change − 0.32 [95% CI − 0.62, − 0.32]). No differences were observed in physical or mental health. Reductions in other primary care services (e.g., in-home nursing, practical assistance) were associated with greater decline in cognitive function (MoCa-change − 0.94 [− 1.53, − 0.36]), particularly among men (MoCa-change − 2.12 [− 3.13, − 1.11]). Men also had a decline in physical function (SPPB-change − 1.06 [− 1.79, − 0.33]). No differences in mental health were observed. Reductions in specialist healthcare services were unrelated to health changes in the overall sample but linked to improved physical function in women (SPPB-change 0.32 [0.11, 0.53]). Although associations between reduced healthcare service use during the pandemic and cognitive, physical, and mental health were limited, findings highlight the importance of sustaining access to primary care for older adults during public health crises. Trial registration The study is pre-registered at ClinicalTrials.gov 02.02.2021, with the identification number NCT 04792086.

• Ibsen, Tanja Louise; Zotcheva, Ekaterina; Bergh, Sverre; Gerritsen, Debby L.; Livingston, Gill & Lurås, Hilde [Show all 12 contributors for this article] (2025). The role of social media in mitigating the long‐term impact of social isolation on mental and cognitive health in older adults during the COVID‐19 pandemic: the HUNT study. International Journal of Geriatric Psychiatry. ISSN 0885-6230. 40(5), p. 1–9. doi: 10.1002/gps.70097. Full text in Research Archive Show summary

  Background: The COVID-19 pandemic increased social isolation in older adults, promoting mental and cognitive decline. The impact of social media on these effects remains unclear. Aim: To investigate the long-term association of social isolation with mental and cognitive health in older adults and whether social media use mitigated this association. Method: Data from the Norwegian Trøndelag Health Study before (2017–2019), during (January 2021), and after the pandemic (2021–2023) were analysed (N = 4844, 53% women, mean age 80 years). Multi-adjusted mixed-effects linear regression estimated differences in changes in mental (CONOR-MHI) and cognitive (MoCA) health related to self-reported social isolation and social media use. Beta (β) represents differences in change in z-score of CONOR-MHI or MoCA. Results: Social isolation was associated with a steeper decline in mental health than no social isolation (β = 0.07, 95% CI 0.01, 0.13) but was not associated with change in cognitive health. Daily social media use was not related to change in mental health, whereas it was associated with a less steep cognitive decline than no social media use (< 1 h: β = 0.13, 95% CI 0.05, 0.20; ≥ 1 h: β = 0.10, 95% CI 0.01, 0.15). Stratified by social isolation, daily social media use < 1 h was related to a less steep cognitive decline than no social media use in both isolated (β = 0.15, 95% CI 0.02, 0.28) and non-isolated individuals (β = 0.13, 95% CI 0.03, 0.22). Conclusion: Individuals experiencing social isolation during the pandemic had a steeper decline in mental, but not cognitive health, compared to those not isolated. Social media use did not buffer the decline in mental health but was associated with less steep cognitive decline. The pandemic showed limits of relying solely on digital solutions for social contact.

• Ibsen, Tanja Louise; Zotcheva, Ekaterina; Bergh, Sverre; Gerritsen, Debby L.; Livingston, Gill & Lurås, Hilde [Show all 11 contributors for this article] (2025). A longitudinal cohort study on dispensed analgesic and psychotropic medications in older adults before, during, and after the COVID-19 pandemic : the HUNT study. BMC Geriatrics. 25(1). doi: 10.1186/s12877-025-05745-8. Full text in Research Archive Show summary

  Background: There is a growing concern and debate over the inappropriate use of analgesics and psychotropic medications by older adults, especially those with dementia. The long-term effects of the COVID-19 pandemic and lockdown measures on these prescriptions remain uncertain. Aim: The primary aim was to examine changes in the prescription of analgesics (opioids and other analgesics) and psychotropics (anxiolytics/sedatives, antidepressants, and antipsychotics) in Norwegian home-dwelling older adults before, during, and up to 2 years after the COVID-19 lockdown, with a particular focus on dementia status. Secondarily, we explored individual characteristics associated with changes in medication prescriptions. Methods: A prospective cohort study using baseline data from 10,464 participants (54% females, mean age 76 years [SD 5.8]) from the Norwegian Trøndelag Health Study (HUNT4 70+) linked with the Norwegian Prescription Database. Age- and education-adjusted Poisson regression was applied to examine changes in prescription fills, and multilevel mixed-effects linear regression was used to estimate the mean sum of defined daily dose (DDD) per person per period during the lockdown (March–September 2020) compared to that during the corresponding months (March–September) in 2019, 2021, and 2022. Results: Overall, prescriptions of opioids, other analgesics, and anxiolytics/sedatives were higher in 2022 than during the lockdown. People without dementia had increased prescriptions of opioids, other analgesics, and antidepressants after lockdown, whereas no changes were observed among those with dementia. Increases in prescriptions of opioids, other analgesics, anxiolytics/sedatives, and antidepressants between the lockdown and 2022 occurred mainly among those aged < 80 years, without comorbidities or mental distress, with good physical function, low fear of COVID-19, and no social isolation during COVID-19. Conclusion: An increase in analgesics and psychotropics after the lockdown was predominantly observed among younger-old and healthier participants. This indicates that in high-income countries, such as Norway, home-dwelling vulnerable individuals seem to have received adequate care. However, the pandemic may have increased the number of vulnerable individuals. These findings should be considered when identifying future nationwide stressors that may impair social interactions and threaten mental health. They also highlight the need to evaluate medication prescriptions for older adults after the pandemic.

• Stenmarck, Mille Sofie; Whitehurst, David GT; Lurås, Hilde & Rugkåsa, Jorun (2024). “It’s hard to say anything definitive about what severity really is”: lay conceptualisations of severity in a healthcare context. BMC Health Services Research. 24(1). doi: 10.1186/s12913-024-10892-6. Full text in Research Archive Show summary

  Background: Demand for healthcare outweighs available resources, making priority setting a critical issue. ‘Severity’ is a priority-setting criterion in many healthcare systems, including in Norway, Sweden, the Netherlands, and the United Kingdom. However, there is a lack of consensus on what severity means in a healthcare context, both in the academic literature and in policy. Further, while public preference elicitation studies demonstrate support for severity as a relevant concern in priority setting, there is a paucity of research on what severity is taken to mean for the public. The purpose of this study is to explore how severity is conceptualised by members of the general public. Methods: Semi-structured group interviews were conducted from February to July 2021 with members of the Norwegian adult public (n = 59). These were transcribed verbatim and subjected to thematic analysis, incorporating inductive and deductive elements. Results: Through the analysis we arrived at three interrelated main themes. Severity as subjective experience included perceptions of severity as inherently subjective and personal. Emphasis was on the individual’s unique insight into their illness, and there was a concern that the assessment of severity should be fair for the individual. The second theme, Severity as objective fact, included perceptions of severity as something determined by objective criteria, so that a severe condition is equally severe for any person. Here, there was a concern for determining severity fairly within and across patient groups. The third theme, Severity as situation dependent, included perceptions of severity centered on second-order effects of illness. These included effects on the individual, such as their ability to work and enjoy their hobbies, effects on those surrounding the patient, such as next of kin, and effects at a societal level, such as production loss. We also identified a concern for determining severity fairly at a societal level. Conclusions: Our findings suggest that severity is a polyvalent notion with different meanings attached to it. There seems to be a dissonance between lay conceptualisations of severity and policy operationalisations of the term, which may lead to miscommunications between members of the public and policymakers.

• Nystrøm, Vivian; Lurås, Hilde; Moger, Tron Anders & Leonardsen, Ann-Chatrin Linqvist (2024). Patient experiences and clinical outcomes of admissions to municipal acute wards versus a hospital: A multicentre randomised controlled trial in Norway. Scandinavian Journal of Primary Health Care. ISSN 0281-3432. 42(4), p. 659–667. doi: 10.1080/02813432.2024.2377727. Full text in Research Archive Show summary

  Background: In Norway, municipal acute wards (MAWs) were implemented as alternatives to hospitalisation. Evaluations of the quality of MAW services are lacking. The primary objective of this study was to compare patient experiences after admission to a MAW versus to a hospital. The secondary objective was to compare ‘readmissions’, ‘length of stay’, ‘self-assessed health-related quality of life’ as measured by the EuroQol 5 items 5 level (EQ-5D-5L) index, and ‘health status’ measured by the RAND-12, in patients admitted to a MAW versus a hospital. Methods: A multicentre randomised controlled trial (RCT), randomising patients to either MAW or hospital. Results: In total, 164 patients were enrolled in the study; 115 were randomised to MAW and 49 to hospital. There were no significant differences between the MAW and hospital groups regarding patient experience, which was rated positively in both groups. Patients in the MAW group reported significantly better physical health status as measured by the RAND-12 four to six weeks after admittance than those randomised to hospital (physical component summary score, 31.7 versus 27.1, p=0.04). The change in EQ-5D index score from baseline to four to six weeks after admittance was significantly greater among patients randomised to MAWs versus hospitals (0.20 versus 0.02, p=0.03). There were no other significant differences between the MAW and hospital groups. Conclusions: In this study, patient experiences and readmissions were similar, whether patients were admitted to a MAW or a hospital. The significant differences in health status and quality of life favouring the MAWs suggest that these healthcare services may be better for elderly patients. However, unfortunately we did not reach the planned sample size due to challenges in the data collection posed by the Covid-19 pandemic.

• Ibsen, Tanja Louise; Strand, Bjørn Heine; Bergh, Sverre; Livingston, Gill; Lurås, Hilde & Mamelund, Svenn-Erik [Show all 11 contributors for this article] (2024). A longitudinal cohort study on the use of health and care services by older adults living at home with/without dementia before and during the COVID-19 pandemic: the HUNT study. BMC Health Services Research. 24. doi: 10.1186/s12913-024-10846-y. Full text in Research Archive Show summary

  Background: Older adults and people with dementia were anticipated to be particularly unable to use health and care services during the lockdown period following the COVID-19 pandemic. To better prepare for future pandemics, we aimed to investigate whether the use of health and care services changed during the pandemic and whether those at older ages and/or dementia experienced a higher degree of change than that observed by their counterparts. Methods: Data from the Norwegian Trøndelag Health Study (HUNT4 70 + , 2017–2019) were linked to two national health registries that have individual-level data on the use of primary and specialist health and care services. A multilevel mixed-effects linear regression model was used to calculate changes in the use of services from 18 months before the lockdown, (12 March 2020) to 18 months after the lockdown. Results: The study sample included 10,607 participants, 54% were women and 11% had dementia. The mean age was 76 years (SD: 5.7, range: 68–102 years). A decrease in primary health and care service use, except for contact with general practitioners (GPs), was observed during the lockdown period for people with dementia (p < 0.001) and those aged ≥ 80 years without dementia (p = 0.006), compared to the 6-month period before the lockdown. The use of specialist health services decreased during the lockdown period for all groups (p ≤ 0.011), except for those aged < 80 years with dementia. Service use reached levels comparable to pre-pandemic data within one year after the lockdown. Conclusion: Older adults experienced an immediate reduction in the use of health and care services, other than GP contacts, during the first wave of the COVID-19 pandemic. Within primary care services, people with dementia demonstrated a more pronounced reduction than that observed in people without dementia; otherwise, the variations related to age and dementia status were small. Both groups returned to services levels similar to those during the pre-pandemic period within one year after the lockdown. The increase in GP contacts may indicate a need to reallocate resources to primary health services during future pandemics. Trial registration: The study is registered at ClinicalTrials.gov, with the identification number NCT 04792086.

• Strømsvik, Nina; Olsson, Pernilla Marie A.; Gravdehaug, Berit; Lurås, Hilde; Schlichting, Ellen & Jørgensen, Kjersti [Show all 11 contributors for this article] (2022). “It was an important part of my treatment”: a qualitative study of Norwegian breast Cancer patients’ experiences with mainstreamed genetic testing. Hereditary Cancer in Clinical Practice. ISSN 1731-2302. 20(6). doi: 10.1186/s13053-022-00212-6. Full text in Research Archive Show summary

  Background: In South-Eastern Norway, genetic testing for BRCA1 and BRCA2 is offered to breast cancer patients by their treating surgeon or oncologist. Genetic counselling from a geneticist or a genetic counsellor is offered only to those who test positive for a pathogenic variant or have a family history of cancer. This practice is termed "mainstreamed genetic testing". The aim of this study was to learn about patients' experience of this healthcare service. Methods: Qualitative in-depth interviews were conducted with 22 breast cancer patients who had been diagnosed during the first half of 2016 or 2017 at one regional and one university hospital and who had been offered testing by their treating physician. A six-phase thematic approach was used to analyse the data. Results: The participants had varied experiences of how and when testing was offered. Three main themes emerged from the analysis: 1. informational and communicational needs and challenges during a chaotic time, 2. the value of genetic testing and 3. the importance of standardised routines for mainstreamed genetic testing. Conclusions: Despite the shock of their diagnosis and the varying experiences they had in respect of how and when testing was offered, all of the participants emphasised that genetic testing had been an important part of their diagnosis and treatment. Our results indicate that there is a need for continuous collaboration between geneticists, surgeons, oncologists and laboratory specialists in order to establish simple and robust routines so as to ensure that all eligible breast cancer patients are offered testing at a point when the test result can have an impact on treatment. Keywords: BRCA1, BRCA2; Breast cancer; Genetic testing for breast cancer; Mainstreamed genetic testing; Qualitative study.

• Nystrøm, Vivian; Lurås, Hilde; Moger, Tron Anders & Leonardsen, Ann-Chatrin Linqvist (2022). Finding good alternatives to hospitalisation: a data register study in five municipal acute wards in Norway. BMC Health Services Research. 22, p. 1–12. doi: 10.1186/s12913-022-08066-3. Full text in Research Archive Show summary

  Background: In Norway, municipal acute wards (MAWs) have been implemented in primary healthcare since 2012. The MAWs were intended to offer decentralised acute medical care 24/7 for patients who otherwise would be admit‑ ted to hospital. The aim of this study was to assess whether the MAW represents the alternative to hospitalisation as intended, through 1) describing the characteristics of patients intended as candidates for MAWs by primary care physicians, 2) exploring the need for extended diagnostics prior to admission in MAWs, and 3) exploring factors asso‑ ciated with patients being transferred from the MAWs to hospital. Methods: The study was based on register data from five MAWs in Norway in the period 2014–2020. Results: In total, 16 786 admissions were included. The median age of the patients was 78 years, 60% were women, and the median length of stay was three days. Receiving oral medication (OR 1.23, 95% CI 1.09–1.40), and the MAW being located nearby the hospital (OR 2.29, 95% CI 1.92–2.72) were factors associated with patients admitted to MAW after extended diagnostics. Patients needing advanced treatment, such as oxygen therapy (OR 2.13, 95% CI 1.81–2.51), intravenous medication (OR 1.60, 95% CI 1.45–1.81), intravenous fluid therapy (OR 1.32, 95% CI 1.19–1.47) and MAWs with long travel distance from the MAW to the hospital (OR 1.46, 95% CI 1.22–1.74) had an increased odds for being transferred to hospital. Conclusions: Our findings indicate that MAWs do not represent the alternative to hospitalisation as intended. The results show that patients receiving extended diagnostics before admission to MAW got basic treatment, while patients in need of advanced medical treatment were transferred to hospital from a MAW. This indicates that there is still a potential to develop MAWs in order to fulfil the intended health service level

• Leonardsen, Ann-Chatrin Linqvist; Werner, Anne; Lurås, Hilde & Johannessen, Anne-Kari M. (2022). Hospital physicians’ experiences and reflections on their work and role in relation to older patients’ pathways - a qualitative study in two Norwegian hospitals. BMC Health Services Research. 22(1). doi: 10.1186/s12913-022-07846-1. Full text in Research Archive Show summary

  Background: Older patients are the most frequent users of initial hospital admissions and readmissions. Both hosptal admission and discharge require communication and coordination between healthcare professionals within the hospital, and between professionals in hospitals and primary healthcare. We have identifed few studies exploring hospital physicians’ perspectives on older patients’ pathways in the interface between hospital and primary healthcare services. The aim of this study was to explore hospital physicians’ experiences and refections on their work and role in relation to older patients’ pathways between hospital and primary healthcare. Specifcally, we focused on the challenges they faced and how they dealt with these in relation to admission and discharge, and their suggestions for service improvements that could facilitate older patients’ pathway. Methods: We used a qualitative approach, conducting individual in-depth interviews with 18 hospital physicians from two hospitals in eastern Norway. Data were analyzed using systematic text condensation, in line with a four-step prosedure developed by Malterud. Results: The participants emphasized challenges in the communication about patients across the two service levels. Moreover, they described being in a squeeze between prioritizing patients and trying to ensure a proper fow of patients through the hospital wards, but with restricted possibilities to infuence on the admissions. They also described a frustration regarding the lack of infuence on the healthcare delivery after discharge. The participants had various suggestions for service improvements which might be benefcial to older patients. Conclusions: The results demonstrate that the hospital physicians perceived being squeezed between professional autonomy and limited capacity at the hospital, and between their medical judgement as a specialist and their power to decide on hospital admissions for old patients and also on the delivery of health care services to patients after discharge.

• Nystrøm, Vivian; Lurås, Hilde; Midlov, Patrik & Leonardsen, Ann-Chatrin Linqvist (2021). What if something happens tonight? A qualitative study of primary care physicians’ perspectives on an alternative to hospital admittance. BMC Health Services Research. 21(1), p. 1–10. doi: 10.1186/s12913-021-06444-x. Full text in Research Archive Show summary

  Background Due to demographic changes, hospital emergency departments in many countries are overcrowded. Internationally, several primary healthcare models have been introduced as alternatives to hospitalisation. In Norway, municipal acute wards (MAWs) have been implemented as primary care wards that provide observation and medical treatment for 24 h. The intention is to replace hospitalisation for patients who require acute admission but not specialist healthcare services. The aim of this study was to explore primary care physicians’ (PCPs’) perspectives on admission to a MAW as an alternative to hospitalisation. Methods The study had a qualitative design, including interviews with 21 PCPs in a county in southeastern Norway. Data were analysed with a thematic approach. Results The PCPs described uncertainty when referring patients to the MAW because of the fewer diagnostic opportunities there than in the hospital. Admission of patients to the MAW was assumed to be unsafe for both PCPs, MAW nurses and physicians. The PCPs assumed that medical competence was lower at the MAW than in the hospital, which led to scepticism about whether their tentative diagnoses would be reconsidered if needed and whether a deterioration of the patients’ condition would be detected. When referring patients to a MAW, the PCPs experienced disagreements with MAW personnel about the suitability of the patient. The PCPs emphasised the importance of patients’ and relatives’ participation in decisions about the level of treatment. Nevertheless, such participation was not always possible, especially when patients’ wishes conflicted with what PCPs considered professionally sound. Conclusions The PCPs reported concerns regarding the use of MAWs as an alternative to hospitalisation. These concerns were related to fewer diagnostic opportunities, lower medical expertise throughout the day, uncertainty about the selection of patients and challenges with user participation. Consequently, these concerns had an impact on how the PCPs utilised MAW services.

• Grindedal, Eli Marie; Jørgensen, Kjersti; Olsson, Pernilla Marie A.; Gravdehaug, Berit; Lurås, Hilde & Schlichting, Ellen [Show all 10 contributors for this article] (2020). Mainstreamed genetic testing of breast cancer patients in two hospitals in South Eastern Norway. Familial Cancer. ISSN 1389-9600. 19(2), p. 133–142. doi: 10.1007/s10689-020-00160-x. Full text in Research Archive Show summary

  Studies have shown that a significant number of eligible breast cancer patients are not offered genetic testing or referral to genetic counseling. To increase access to genetic testing in South Eastern Norway, testing has since 2014 been offered directly to breast cancer patients by surgeons and oncologists. This practice is termed "mainstreamed genetic testing". The aim of this study was to investigate to what extent patients in South Eastern Norway are offered testing. Three hundred and sixty one patients diagnosed in 2016 and 2017 at one regional and one university hospital in South Eastern Norway were included. Data on whether the patients fulfilled the criteria, whether they had been offered testing and if they were tested were collected. In total, 26.6% (96/361) fulfilled the criteria for testing. Seventy five percent (69/92) of these were offered testing, and 71.7% (66/92) were tested. At the university hospital, 90.2% (37/41) of eligible patients were offered testing, and at the regional hospital 62.7% (32/51). Fifty two percent (12/23) of eligible patient not offered testing were younger than 50 years at time of diagnosis. As many as 95.4% (125/131) of all patients who were offered testing, wanted to be tested. The majority of patients who fulfilled the criteria were offered testing, supporting the practice of mainstreamed genetic testing. There were nevertheless differences in rates of testing between the hospitals that affected all groups of patients, indicating that genetic testing may not be equally accessible to all patients. We suggest that efforts should be made to increase awareness and improve routines for genetic testing of breast cancer patients in Norway. Keywords: BRCA; Breast cancer; Genetic testing; Mainstreaming cancer genetics.

• Aae, Tommy Frøseth; Randsborg, Per-Henrik; Lurås, Hilde; Årøen, Asbjørn & Lian, Øystein Bjerkestrand (2017). Microfracture is more cost-effective than autologous chondrocyte implantation: a review of level 1 and level 2 studies with 5 year follow-up. Knee Surgery, Sports Traumatology, Arthroscopy. ISSN 0942-2056. 26(4), p. 1044–1052. doi: 10.1007/s00167-017-4802-5. Full text in Research Archive Show summary

  Purpose Focal cartilage defects in the knee may have devastating effect on the knee joint, where two of the main surgical treatment options are microfracture and autologous chondrocyte implantation. Comparative studies have failed to establish which method yields the best clinical results. A cost-effectiveness analysis of microfracture and autologous chondrocyte implantation would contribute to the clinical decision process. Methods A PubMed search identifying level I and level II studies with 5 year follow-up was performed. With the data from these studies, decision trees with associated service provision and costs connected to the two different techniques were designed. In addition to hospital costs, we included costs connected to physiotherapy following surgery. To paint a broader cost picture, we also included indirect costs to the society due to productivity loss caused by work absence. Results Four high-quality studies, with a follow-up of 5 years, met the inclusion criteria. A total of 319 patients were included, 170 undergoing microfracture and 149 autologous chondrocyte implantation. The re-operation rate was 23 (13.5%) following microfracture, and 18 (12.1%) for autologous chondrocyte implantation. Both groups achieved substantially better clinical scores at 5 years compared to baseline. Microfracture was more cost-effective when comparing all clinical scores. Conclusion Microfracture is associated with both lower costs and lower cost per point increase in patient reported outcome measures. There is a need of well-designed, high-quality randomized controlled trials before reliable conclusions regarding cost-effectiveness in the long run is possible. Level of evidence III.

• Ree, Anne Hansen; Russnes, Hege Elisabeth Giercksky; Heinrich, Daniel; Dueland, Svein; Pedersen, Kjetil Boye & Nygaard, Vigdis [Show all 34 contributors for this article] (2017). Implementing precision cancer medicine in the public health services of Norway: the diagnostic infrastructure and a cost estimate. ESMO Open. 2(2), p. 1–10. doi: 10.1136/esmoopen-2017-000158. Full text in Research Archive Show summary

  Objective Through the conduct of an individual-based intervention study, the main purpose of this project was to build and evaluate the required infrastructure that may enable routine practice of precision cancer medicine in the public health services of Norway, including modelling of costs. Methods An eligible patient had end-stage metastatic disease from a solid tumour. Metastatic tissue was analysed by DNA sequencing, using a 50-gene panel and a study-generated pipeline for analysis of sequence data, supplemented with fluorescence in situ hybridisation to cover relevant biomarkers. Cost estimations compared best supportive care, biomarker-agnostic treatment with a molecularly targeted agent and biomarker-based treatment with such a drug. These included costs for medication, outpatient clinic visits, admission from adverse events and the biomarker-based procedures. Results The diagnostic procedures, which comprised sampling of metastatic tissue, mutation analysis and data interpretation at the Molecular Tumor Board before integration with clinical data at the Clinical Tumor Board, were completed in median 18 (8-39) days for the 22 study patients. The 23 invasive procedures (12 from liver, 6 from lung, 5 from other sites) caused a single adverse event (pneumothorax). Per patient, 0–5 mutations were detected in metastatic tumours; however, no actionable target case was identified for the current single-agent therapy approach. Based on the cost modelling, the biomarker-based approach was 2.5-fold more costly than best supportive care and 2.5-fold less costly than the biomarker-agnostic option. Conclusions The first project phase established a comprehensive diagnostic infrastructure for precision cancer medicine, which enabled expedite and safe mutation profiling of metastatic tumours and data interpretation at multidisciplinary tumour boards for patients with end-stage cancer. Furthermore, it prepared for protocol amendments, recently approved by the designated authorities for the second study phase, allowing more comprehensive mutation analysis and opportunities to define therapy targets.

• Dahl, Fredrik Andreas; Benth, Jurate Saltyte; Aas, Eline & Lurås, Hilde (2017). Economic Productivity loss due to breast cancer in Norway - a case control study using the human capital approach. Nordic Journal of Health Economics. ISSN 1892-9729. doi: 10.5617/njhe.2981. Full text in Research Archive
• Holm, Anne Guro Vreim; Lurås, Hilde & Randsborg, Per-Henrik (2016). The economic burden of outpatient appointments following paediatric fractures. Injury. ISSN 0020-1383. 47(7), p. 1410–1413. doi: 10.1016/j.injury.2016.04.007. Full text in Research Archive
• Hektoen, Liv Faksvåg; Saltvedt, Ingvild; Sletvold, Olav; Helbostad, Jorunn L.; Lurås, Hilde & Halsteinli, Vidar (2016). One-year health and care costs after hip fracture for home-dwelling elderly patients in Norway: Results from the Trondheim Hip Fracture Trial. Scandinavian Journal of Public Health. ISSN 1403-4948. 44(8), p. 791–798. doi: 10.1177/1403494816674162. Full text in Research Archive Show summary

  Aim: The aim of this study was to estimate the one-year health and care costs related to hip fracture for home-dwelling patients aged 70 years and older in Norway, paying specific attention to the status of the patients at the time of fracture and cost differences due to various patient pathways after fracture. Methods: Data on health and care service provision were extracted from hospital and municipal records and from national registries; data on unit costs were collected from the municipalities, hospital administrations and previously published studies. Four different patient pathways were identified and the total costs for subgroups of patients according to age, sex, fracture type and instrumental activity of daily living at fracture incidence were calculated. Descriptive statistics were used to identify cost estimates. Results: The mean total one-year costs per patient were EUR 68,376 and the costs for patients alive one year after hip fracture were EUR 71,719. The patients’ age and pre-fracture functional status contributed most to the total cost. Conclusions: On average, care costs accounted for more than 50% of the total cost; even for patients with good functional status before hip fracture, care costs accounted for 40% of the total cost compared with hospital costs of 38%. To reduce the financial costs of hip fractures in the care sector, the results point to the importance of preventive programmes to reduce the risk of hip fracture, but also to the importance of comprehensive geriatric care in the initial phase after a hip fracture.

• Yin, Jun; Dahl, Fredrik Andreas; Hagen, Terje P. & Lurås, Hilde (2016). The influence of changes in activity-based financing on hospital readmissions for the elderly. Nordic Journal of Health Economics. ISSN 1892-9729. 4(2), p. 72–81. doi: 10.5617/njhe.992. Full text in Research Archive
• Ydstebø, Arnt Egil; Bergh, Sverre; Selbæk, Geir; Benth, Jurate Saltyte; Lurås, Hilde & Vossius, Corinna Elisabeth (2015). The impact of dementia on the use of general practitioners among the elderly in Norway. Scandinavian Journal of Primary Health Care. ISSN 0281-3432. 33(3), p. 199–205. doi: 10.3109/02813432.2015.1067516. Full text in Research Archive
• Kann, Inger Cathrine; LUNDQVIST, CHRISTOFER & Lurås, Hilde (2015). Polypharmacy among the elderly in a list-patient system. Drugs - real world outcomes. ISSN 2199-1154. doi: 10.1007/s40801-015-0036-3. Full text in Research Archive
• Benth, Jurate Saltyte; Dahl, Fredrik Andreas; Lurås, Hilde & Dahl, Alv A (2014). A controlled study of income development for breast cancer survivors in Norway. Journal of cancer survivorship. ISSN 1932-2259. 8(2), p. 239–247. doi: 10.1007/s11764-013-0324-4. Full text in Research Archive
• Kann, Inger Cathrine; LUNDQVIST, CHRISTOFER & Lurås, Hilde (2014). Prescription of addictive and non-addictive drugs to home-dwelling elderly. Drugs & Aging. ISSN 1170-229X. 31(6), p. 453–459. doi: 10.1007/s40266-014-0169-1. Full text in Research Archive
• Johannessen, Anne-Kari M.; Lurås, Hilde & Steihaug, Sissel (2013). The role of an intermediate unit in a clinical pathway. International Journal of Integrated Care (IJIC). 13:UNSP 114417. doi: 10.5334/ijic.859. Full text in Research Archive Show summary

  Introduction: Different care models have been established to achieve more coordinated clinical pathways for older patients in the transition between hospital and home. This study explores an intermediate unit’s role in a clinical pathway for older patients with somatic diseases. Theory and methods: Qualitative data were collected via interviews, observations, and a questionnaire. Participants included patients and healthcare providers within both specialist and primary healthcare. Transcripts of interviews and field notes were analyzed using a method of systematic text condensation. Results: Healthcare providers in the hospital, the intermediate unit, and the municipalities have different opinions about who is a ‘suitable’ patient for the unit and what is the proper time for hospital discharge. This results in time-consuming negotiations between the hospital and the unit. Incompatible computer systems increase the healthcare provider’s workload. Several informants are doubtful as to whether a stay in the unit is useful to the patients, while the patients are mostly pleased with their stay and the transferral. Conclusion and discussion: This study describes challenges that may occur when a new unit is established in an existing healthcare system in order to achieve an appropriate clinical pathway from hospital to home.

• Holm, Lene Berge; Lurås, Hilde & Dahl, Fredrik Andreas (2013). Improving hospital bed utilisation through simulation and optimisation: With application to a 40% increase in patient volume in a Norwegian general hospital. International Journal of Medical Informatics. ISSN 1386-5056. 82(2), p. 80–89. doi: 10.1016/j.ijmedinf.2012.05.006. Full text in Research Archive
• Yin, Jun; Lurås, Hilde; Hagen, Terje P. & Dahl, Fredrik Andreas (2013). The effect of activity-based financing on hospital length of stay for elderly patients suffering from heart diseases in Norway. BMC Health Services Research. 13. doi: 10.1186/1472-6963-13-172. Full text in Research Archive Show summary

  Background Whether activity-based financing of hospitals creates incentives to treat more patients and to reduce the length of each hospital stay is an empirical question that needs investigation. This paper examines how the level of the activity-based component in the financing system of Norwegian hospitals influences the average length of hospital stays for elderly patients suffering from ischemic heart diseases. During the study period, the activity-based component changed several times due to political decisions at the national level. Methods The repeated cross-section data were extracted from the Norwegian Patient Register in the period from 2000 to 2007, and included patients with angina pectoris, congestive heart failure, and myocardial infarction. Data were analysed with a log-linear regression model at the individual level. Results The results show a significant, negative association between the level of activity-based financing and length of hospital stays for elderly patients who were suffering from ischemic heart diseases. The effect is small, but an increase of 10 percentage points in the activity-based component reduced the average length of each hospital stay by 1.28%. Conclusions In a combined financing system such as the one prevailing in Norway, hospitals appear to respond to economic incentives, but the effect of their responses on inpatient cost is relatively meagre. Our results indicate that hospitals still need to discuss guidelines for reducing hospitalisation costs and for increasing hospital activity in terms of number of patients and efficiency.

• Vossius, Corinna Elisabeth; Ydstebø, Arnt Egil; Testad, Ingelin & Lurås, Hilde (2013). Referrals from nursing home to hospital: Reasons, appropriateness and costs. Scandinavian Journal of Public Health. ISSN 1403-4948. 41(4), p. 366–373. doi: 10.1177/1403494813484398. Full text in Research Archive
• Gautun, Heidi; Werner, Anne & Lurås, Hilde (2012). Care challenges for informal caregivers of chronically ill lung patients: Results from a questionnaire survey. Scandinavian Journal of Public Health. ISSN 1403-4948. 40(1), p. 18–24. doi: 10.1177/1403494811425712. Full text in Research Archive Show summary

  Aims: The article aims to answer who the informal caregivers of patients with chronic obstructive pulmonary disease (COPD) are, what kind of help they provide, and how they experience providing help to the patient. Method: Data from a questionnaire survey to next of kin of COPD patients carried through in Norway in December 2009 and January 2010 is explored. Result: About 70% of the patients have one or more informal caregivers, and a majority of the caregivers is the patient’s spouse, most often a wife. The help provided is, to a large extent, practical help like housework, garden work, and shopping. Another important support is to accompany the patient to health care. About 45% of the caregivers are part of the work force. Rather few of the respondents experience the caregiving as so demanding that they have chosen to work part-time or quit working. The most demanding part of being an informal caregiver is an overall worrying for the patient. Conclusions: Paid sick leaves for caregivers that are employed, and hospital-at-home programmes that provide education and surveillance to the patient and his/her family through different phases of the illness, are policy means that both can help the informal caregivers to manage daily life and reduce the pressure on the formal healthcare and longterm care services in the future.

• Godager, Geir; Lurås, Hilde & Iversen, Tor (2012). Framtidens betalingssystemer i allmennlegetjenesten. In Melberg, Hans Olav & Kjekshus, Lars Erik (Ed.), Fremtidens Helse-Norge. Fagbokforlaget. ISSN 9788245012088. p. 187–204. Full text in Research Archive
• Iversen, Tor & Lurås, Hilde (2012). Capitation and incentives in primary care. In Jones, Andrew M. (Eds.), The Elgar Companion To Health Economics, Second Edition. Edward Elgar Publishing. ISSN 9781849802673. p. 280–288. doi: 10.4337/9781845428914.00037. Full text in Research Archive
• Iversen, Tor & Lurås, Hilde (2011). Patient switching in general practice. Journal of Health Economics. ISSN 0167-6296. 30(5), p. 894–903. doi: 10.1016/j.jhealeco.2011.07.008. Full text in Research Archive Show summary

  Patients switching physicians involves costs to the patients because of less continuity of care. From a theoretical model we derive that inferior physician quality as perceived by patients, implies patient shortage for the physician and more patients switching physicians. By means of a unique panel data set covering the entire population of Norwegian general practitioners (GPs) and estimation methods that adjust for potential endogeneities, we find that the occurrence of patient shortage increases the proportion of patients switching physicians by 50%. A competing hypothesis that GPs with a shortage of patients experience less switching because of superior access is rejected by data. To assist patients in making informed decisions, we suggest that the number of switches a physician experiences should be made public.

• Holmås, Tor Helge; Kjerstad, Egil; Lurås, Hilde & Straume, Odd Rune (2010). Does monetary punishment crowd out pro-social motivation? A natural experiment on hospital length of stay. Journal of Economic Behavior and Organization. ISSN 0167-2681. 75(2), p. 261–267. doi: 10.1016/j.jebo.2010.03.024. Full text in Research Archive
• Kann, Inger Cathrine; Biørn, Erik & Lurås, Hilde (2010). Competition in general practice: Prescriptions to the elderly in a list patient system. Journal of Health Economics. ISSN 0167-6296. 29(5), p. 751–764. doi: 10.1016/j.jhealeco.2010.07.004. Full text in Research Archive Show summary

  Income motivation among general practitioners is frequently discussed in the health economics literature. The question addressed in the present study on reimbursement drugs and addictive drugs is whether increased competition among GPs, which is part of a declared health policy to improve efficiency, contributes to more prescriptions for the elderly. The dataset comprises registered data of all prescribed drugs dispensed at pharmacies from the Norwegian Prescription Database merged with data on GPs. In choosing a method, particular attention is given to the fact that patients tend to be attracted to GPs who fit their preferences. Hence, we treat the composition of the patient list as endogenous. The results indicate that the stronger competition a GP faces, the more drugs are prescribed, which implies that GPs' prescription style may conflict with their role as gatekeepers, and even worse, it may be a hazard to patients' health.

• Godager, Geir & Lurås, Hilde (2009). Dual job holding general practitioners: the effect of patient shortage. Health Economics. ISSN 1057-9230. 18(10), p. 1133–1145. doi: 10.1002/hec.1418. Full text in Research Archive
• Lurås, Hilde (2007). The association between patient shortage and patient satisfaction with general practitioners. Scandinavian Journal of Primary Health Care. ISSN 0281-3432. Full text in Research Archive
• Eika, Kari & Lurås, Hilde (2006). Forebygge eller behandle? Strategier for bedre helse og funksjonsevne blant eldre. Økonomisk forum. ISSN 1502-6108. 60(5), p. 33–41. Full text in Research Archive
• Carlsen, Benedicte; Iversen, Tor & Lurås, Hilde (2005). Markedsforholdene har fortsatt betydning for fastlegenes praksisutøvelse. Økonomisk forum. ISSN 1502-6108. 59(7), p. 7–10. Full text in Research Archive
• Carlsen, Benedicte; Iversen, Tor & Lurås, Hilde (2005). Markedsforholdenes betydning for allmennlegenes praksisutøvelse. Økonomisk forum. ISSN 1502-6108. 59(4), p. 20–28. Full text in Research Archive
• Carlsen, Benedicte; Iversen, Tor & Lurås, Hilde (2005). Markedsforholdene har fortsatt betydning for fastlegenes praksisutøvelse. Økonomisk forum. ISSN 1502-6108. p. 7–10. Full text in Research Archive
• Lurås, Hilde (2004). HVA VET VI OM INNTEKTSMOTIVERT ADFERD BLANT ALLMENNLEGER? En kritisk gjennomgang av teoretisk og empirisk litteratur. Økonomisk forum. ISSN 1502-6108. 58(9), p. 33–42. Full text in Research Archive
• Lurås, Hilde; Finnvold, Jon Erik & Paulsen, Bård (2003). De fleste fikk den de ville ha. Samfunnsspeilet : Tidsskrift om levekår og livsstil. ISSN 0801-7603. Full text in Research Archive
• Lurås, Hilde & Iversen, Tor (2002). Legemangelen som ble til pasientmangel. Variasjoner i listeønsker og pasientknapphet ved innføring av fastlegeordningen. Økonomisk forum. ISSN 1502-6108. p. 26–31. Full text in Research Archive Show summary

  Før fastlegeordningen ble innført, var helsemyndigheter og andre bekymret for den store mangelen på allmennleger. Ett år etter innføringen viser tall fra Trygdeetaten at nærmere 75 % av norske allmennleger opplever mangel på pasienter. Den forventede mangelen på leger har utviklet seg til å bli en mangel på pasienter. Dette har trolig sammenheng med at per capita tilskuddet oppmuntrer legene til å ønske seg lange pasientlister. Kombinert med stykkprisavlønning kan pasientknappheten vise seg å bli kostbar for staten.

• Iversen, Tor & Lurås, Hilde (2002). Waiting time as a competitive device: an example from general medical practice. International Journal of Health Care Finance and Economics. ISSN 1389-6563. 2, p. 189–204. Full text in Research Archive Show summary

  From a theoretical model we predict that only physicians with quality characteristics perceived as inferior by patients, are willing to embark on waiting time reductions. Because of variation in these quality characteristics among physicians, market equilibrium is likely to show a range of waiting times for physician services. This hypothesis is supported by results from a study of Norwegian general practitioners. Since the waiting time offered by a physician, influences the number of patient-initiated consultations, a policy implication of our study is that the distinction between patient-initiated and physician-initiated consultations may be less clear-cut than often assumed in the literature.

• Iversen, Tor & Lurås, Hilde (2002). The importance of micro-data for revealing income-motivated behavior among GPs. In Lindgren, B. (Eds.), Individual decisions for health. Routledge. Full text in Research Archive Show summary

  The objective of this paper is to demonstrate that micro-data are fundamental for the study of income-motivated behaviour among general practitioners (GPs). We argue that a GP who experiences a shortage of patients in a mixed capitation and fee-for-service payment system, is likely to have a more service-intensive practice style than his unconstrained colleagues. If he cannot have his optimal number of patients, a second best is to increase the number of services per patient if the income per time unit of providing services is greater than the marginal valuation of leisure. An empirical test requires micro-data of GPs' rationing status. Data from the Norwegian capitation experiment provide us with this opportunity. We find that the effect of a patient shortage (strong rationing) on a GP's income from fees per patient is positive and statistically significant. Furthermore, we find that only the municipality with the lowest GP-density has a negative and statistically significant effect. If only GP-density data had been available, we might erroneously have concluded that service provision among GPs is not income-motivated. The reason is that aggregate data miss the intra-municipality variation in the actual number of patients relative to GPs' preferred numbers. We conclude that macro-data on GP-density in an area are not likely to be useful in this context because the effect of better access is not distinguishable from the effect of physician-initiated services.

• Iversen, Tor & Lurås, Hilde (2000). Economic motives and professional norms: The case of general medical practice. Journal of Economic Behavior and Organization. ISSN 0167-2681. 43, p. 447–470. Full text in Research Archive Show summary

  Professional norms are supposed to have a central role in the allocation of resources when consumers have inferior information about the characteristics of products. We argue that economic motives are nevertheless important to resource allocation when professional opinions differ. The argument is illustrated with an example from medical care. We find that physicians who experience a shortage of patients have higher income, longer and more frequent consultations and more laboratory tests per listed person than their unconstrained colleagues.

• Iversen, Tor & Lurås, Hilde (2000). The effect of capitation on GPs' referral decisions. Health Economics. ISSN 1057-9230. 9, p. 199–210. Full text in Research Archive Show summary

  In the Norwegian capitation trial the payment system for GPs has been changed; a practice allowance component is replaced by a capitation component, and the fee-per-item component constitutes a smaller part of a GP's practice income than previously. From the theoretical modelling of GPs' referral decisions we predict that the replacement of the practice allowance by a capitation component will increase the rate of referrals to specialists. This hypothesis is supported by an exploratory empirical study with data from a sample of GPs participating in the experiment.

• Iversen, Tor & Lurås, Hilde (1999). The interaction between patient shortage and patients` waiting time, Working Paper Working Paper 1999:2. Universitetet i Oslo. ISSN 9788277560267. Full text in Research Archive Show summary

  We study the interaction between patient shortage and patients' waiting time to get an appointment. From a theoretical model we predict that physicians experiencing a shortage of patients offer their patients a shorter waiting time than their unconstrained colleagues. This happens because a shorter waiting time is expected to lower the threshold for seeking care, and hence, to increase the number of patient-initiated contacts. But it also happens because a shorter waiting time can be a mean to attract new patients. The hypotheses are supported by some preliminary results from a sample of Norwegian general practitioners participating in a capitation trial.

• Iversen, Tor & Lurås, Hilde (1998). Innføring av fastlegeordning - hva med legenes tilpasning ? Sosialøkonomen. ISSN 0038-1624. 7, p. 26–31. Full text in Research Archive
• Brekke, Kjell Arne; Lurås, Hilde & Nyborg, Karine (1996). Allowing disagreement in evaluations of social welfare. Journal of Economics. ISSN 0931-8658. 63, p. 303–324. Full text in Research Archive

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• Iversen, Tor & Lurås, Hilde (2006). Capitation and incentives in primary care. Edward Elgar Publishing. ISBN 9781845420031. 14 p. Full text in Research Archive

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• Leonardsen, Ann-Chatrin Linqvist; Nystrøm, Vivian; Moger, Tron Anders & Lurås, Hilde (2024). Kommunale akuttavdelinger skulle bli et alternativ til sykehusinnleggelse- men legene stoler ikke på tilbudet. Full text in Research Archive
• Storm, Marianne; Morken, Ingvild Margreta; Austin, Rosalynn; Nordfonn, Oda Karin; Wathne, Hege Bjøkne & Urstad, Kristin Hjorthaug [Show all 18 contributors for this article] (2024). Evaluation of the nurse-assisted eHealth intervention ‘eHealth@Hospital-2-Home’ on self-care by patients with heart failure and colorectal cancer post-hospital discharge : protocol for a randomised controlled trial. doi: 10.1186/s12913-023-10508-5. Full text in Research Archive Show summary

  Background: Patients with heart failure (HF) and colorectal cancer (CRC) are prone to comorbidity, a high rate of readmission, and complex healthcare needs. Self-care for people with HF and CRC after hospitalisation can be challenging, and patients may leave the hospital unprepared to self-manage their disease at home. eHealth solutions may be a beneficial tool to engage patients in self-care. Methods: A randomised controlled trial with an embedded evaluation of intervention engagement and cost-effectiveness will be conducted to investigate the effect of eHealth intervention after hospital discharge on the self-efficacy of self-care. Eligible patients with HF or CRC will be recruited before discharge from two Norwegian university hospitals. The intervention group will use a nurse-assisted intervention—eHealth@Hospital-2-Home—for six weeks. The intervention includes remote monitoring of vital signs; patients’ self-reports of symptoms, health and well-being; secure messaging between patients and hospital-based nurse navigators; and access to specific HF and CRC health-related information. The control group will receive routine care. Data collection will take place before the intervention (baseline), at the end of the intervention (Post-1), and at six months (Post-2). The primary outcome will be self-efficacy in self-care. The secondary outcomes will include measures of burden of treatment, health-related quality of life and 30- and 90-day readmissions. Sub-study analyses are planned in the HF patient population with primary outcomes of self-care behaviour and secondary outcomes of medication adherence, and readmission at 30 days, 90 days and 6 months. Patients’ and nurse navigators’ engagement and experiences with the eHealth intervention and cost-effectiveness will be investigated. Data will be analysed according to intention-to-treat principles. Qualitative data will be analysed using thematic analysis. Discussion: This protocol will examine the effects of the eHealth@ Hospital-2-Home intervention on self-care in two prevalent patient groups, HF and CRC. It will allow the exploration of a generic framework for an eHealth intervention after hospital discharge, which could be adapted to other patient groups, upscaled, and implemented into clinical practice.

• Ibsen, Tanja Louise; Strand, Bjørn Heine; Rokstad, Anne Marie Mork; Bergh, Sverre; Mamelund, Svenn-Erik & Lurås, Hilde [Show all 7 contributors for this article] (2023). The use of health care services before and during the COVID-19 pandemic for home dwelling older adults with and without dementia in Norway. A HUNT-study. Full text in Research Archive
• Nystrøm, Vivian; Lurås, Hilde; Moger, Tron Anders & Leonardsen, Ann-Chatrin Linqvist (2023). Finding good alternatives to hospitalisation.A data register study in five municipal acute wards in Norway​. Full text in Research Archive
• Nystrøm, Vivian; Lurås, Hilde; Midlov, Patrik & Leonardsen, Ann-Chatrin Linqvist (2023). Tenk om det skjer noe i natt? Kommunale legers erfaringer med å henvise pasienter til kommunale akutte døgnenheter. Full text in Research Archive
• Nystrøm, Vivian; Lurås, Hilde; Moger, Tron Anders & Leonardsen, Ann-Chatrin Linqvist (2023). Patient experiences and clinical outcomes of admissions to municipal acute wards versus a hospital.A multicenter randomised controlled trial in Norway. Full text in Research Archive
• Leonardsen, Ann-Chatrin Linqvist; Werner, Anne; Lurås, Hilde & Johannessen, Anne-Kari M. (2022). Bedre kommunikasjon kan styrke pasientforløpet for eldre. Full text in Research Archive
• Strømsvik, Nina; Olsson, Pernilla Marie A.; Gravdehaug, Berit; Mæhle, Lovise Olaug; Lurås, Hilde & Schlichting, Ellen [Show all 11 contributors for this article] (2021). Breast Cancer Patients' Experiences with Mainstreamed Genetic Testing in Two Hospitals in South Eastern Norway - Preliminary results. Full text in Research Archive Show summary

  Background: In South Eastern Norway, genetic testing of BRCA1 and BRCA2 is mainstreamed into regular oncological care. Testing is offered directly to breast cancer (BC) patients by surgeons and oncologists. Only patients who test positive for a pathogenic BRCA variant or have a family history of cancer, are referred to genetic counseling. The aim of this study was to gain knowledge on how BC patients experience this health care service. Methods: Thirty women, diagnosed with BC during the first half of 2016 or 2017 at one regional and one university hospital, and who had been tested by their treating physician were invited.. Twenty two (73%) consented to inclusion, and qualitative individual interviews were undertaken with all of them. The data were analysed using a thematic approach. Results: Being diagnosed with BC was a shock that created a need for and an obstacle to absorbing and remembering information. A feeling of trust in the health care providers facilitated communication in this chaotic period. The women regarded genetic testing as important for themselves, their cancer treatment and their relatives. The participants’ experience of how genetic testing was offered, the amount of information they received and how they had received the test result varied. Not all patients had been offered testing, and some had asked for the test themselves. The participants emphasized the importance of having routines to secure that all eligible patients were given the opportunity of being tested. Conclusions: Based on the findings in this qualitative study of BC patients’ experience with mainstreamed genetic testing, we conclude that access to testing during diagnosis and treatment had been important to these women. Their varied experiences regarding when and how they had been offered testing indicate that there may be a need to strengthen and unify routines for this health care service.

• Strømsvik, Nina; Olsson, Pernilla Marie A.; Gravdehaug, Berit; Mæhle, Lovise; Schlichting, Ellen & Lurås, Hilde [Show all 11 contributors for this article] (2021). Eighth International Symposium on hereditary breast and ovarian cancer. Familial Cancer. Familial Cancer. ISSN 1389-9600. doi: 10.1007/s10689-021-00273-x. Full text in Research Archive
• Werner, Anne; Lurås, Hilde & Johannessen, Anne-Kari M. (2019). Skadelig alkoholbruk hos (eldre) pasienter: et fortiet tema i sykehus? Full text in Research Archive
• Aae, Tommy Frøseth; Randsborg, Per-Henrik; Lurås, Hilde; Årøen, Asbjørn & Lian, Øystein Bjerkestrand (2017). MIKROFRAKTUR VERSUS AUTOLOG CHONDROCYTTIMPLANTASJON – EN KOSTNADSEFFEKTIV ANALYSE. Full text in Research Archive
• Holm, Anne Guro Vreim; Lurås, Hilde & Randsborg, Per-Henrik (2016). Helseøkonomiske vurderinger av polikliniske kontroller ved frakturer i overekstermiteten hos barn. Koster det mer enn det smaker? Full text in Research Archive
• Ringard, Ånen; Tveter, Ellen C; Lurås, Hilde & Ingebrigtsen, Tor (2013). The impact of health care reform on quality and patient safety in Norway. Full text in Research Archive
• Iversen, Tor & Lurås, Hilde (2007). The impact of quality perception on patients switching physicians in a list patient system. Full text in Research Archive
• Gulbrandsen, Pål; Lurås, Hilde & Vendshol, Turid (2006). A study of the integration of a primary care emergency ward and a hospital emergency unit. Socialmedicinsk Tidskrift (SMT). ISSN 0037-833X. Full text in Research Archive
• Iversen, Tor & Lurås, Hilde (2006). The impact of service provision on patient switching in a list patient system. Full text in Research Archive
• Iversen, Tor & Lurås, Hilde (2006). The impact of service provision on patient switching in a list patient system. Full text in Research Archive
• Godager, Geir & Lurås, Hilde (2004). The effect of patient shortage on the GPs' involvement in the community health service. Full text in Research Archive
• Lurås, Hilde & Godager, Geir (2004). The effect of patient shortage on the GPs' involvement in the community health service. Full text in Research Archive
• Lurås, Hilde (2004). Choosing a GP. Experiences from the implementation of a listpatient system in Norway. Full text in Research Archive
• Lurås, Hilde (2004). Hva vet vi om inntektsmotivert adferd blant allmennleger? Full text in Research Archive
• Lurås, Hilde (2003). Fastlegeordningen: De fleste fikk den de ville ha. Samfunnsspeilet : Tidsskrift om levekår og livsstil. ISSN 0801-7603. p. 2–11. Full text in Research Archive
• Lurås, Hilde (2003). Individuals' preferences for GPs. Choice analysis from the establishment of a list patient system in Norway. Full text in Research Archive
• Lurås, Hilde (2003). Individuals' preferences for GPs. Choice analysis from the establishment of a list patient system in Norway. Full text in Research Archive
• Lurås, Hilde (2003). Hva bestemmer befolkningens valg og tildeling av fastlege? Full text in Research Archive
• Lurås, Hilde (2003). Individuals' preferences for GPs. Choice analysis from the establishment of a list patient system in Norway. Full text in Research Archive
• Iversen, Tor & Lurås, Hilde (1998). The interaction between patient shortage and patients' waiting time in general practice. Full text in Research Archive
• Finnvold, Jon Erik & Lurås, Hilde (1998). Longitudinal and personal continuity of care in general practice. Full text in Research Archive
• Iversen, Tor & Lurås, Hilde (1996). Do economic constraints influence the provision of health services in general practice. Full text in Research Archive Show summary

  We study GPs¿ choice of optimal service provision under alternative payment systems. When there is fee per item component in the payment system we show that phycisians who experience a shortage of patients, are likely to have a more service intensive practice style than their unconstrained colleagues. Data from the Norwegian capitation experiment is used to test the hypothesis. We find that physicians with shorter individual lists than they wished to have when the experiment started, had a larger income per person enlisted than their unconstrained colleagues. There are, however, important modifications.

• Brekke, Kjell Arne; Bruvoll, Annegrete; Lurås, Hilde & Nyborg, Karine (1993). Nytte-kostnadsanalyser og miljøprising. En moralfilosofisk kritikk. Sosialøkonomen. ISSN 0038-1624. 7/8, p. 8–15. Full text in Research Archive
• Selbæk, Geir; Vossius, Corinna Elisabeth; Lurås, Hilde & Godager, Geir (2012). Resource Use and Disease Course in Dementia (REDIC). Avdeling for helseledelse og helseøkonomi, Universitetet i Oslo. Full text in Research Archive
• Iversen, Tor & Lurås, Hilde (2008). Patient switching in a list patient system. Health Economics Research Programme at the University of Oslo. ISSN 9788277561875. Full text in Research Archive Show summary

  We study whether the information patients have about physician quality when they choose a physician, influences their probability of switching physicians. We also study whether a physician with unfavorable characteristics, as perceived by patients (ex post), can compensate for patient switching by providing a higher quantity of services to his patients. If so, a trade-off exists between quality characteristics and quantity of services in the physician services market. From panel data covering the entire population of Norwegian general practitioners, we find that information on physician quality, as perceived by patients, has a huge effect on the volume of patients switching physicians. We also find that although physicians who experience patient shortages in general provide more services to their patients than physicians who have enough patients, the increased level of service provision only has a very small impact on the number of patients who decide to switch. We conclude that a higher level of service provision does not seem to compensate for negative characteristics (patients’ impression of competence, empathy etc) of less popular physicians. We suggest that information about the volume of patient switching at the physician practice level should be made public.

• Godager, Geir; Iversen, Tor & Lurås, Hilde (2007). Fastlegeordningen: Utvikling i bruk, tilgjengelighet og fornøydhet. Health Economic Research Programme at the University of Oslo. ISSN 9788277561783. Full text in Research Archive
• Lurås, Hilde; Holmås, Tor Helge; Kjerstad, Egil & Kristiansen, Frode (2007). Long term care and hospital length of stay for elderly patients. Samfunns- og næringslivsforskning (SNF). Full text in Research Archive Show summary

  The proportion of elderly people in the population is increasing and old patients’ bed occupancy rate in hospitals increases as a fraction of total bed occupancy. Because old patients, on average, are frailer than other age groups their length of stay (LOS) at hospitals is longer than average. In this paper we ask whether or not frailty and the need of more comprehensive hospital treatment are the only explanation behind a comparatively long LOS for elderly patients. Of particular interest is the fact that within health care for the elderly there may be conflicting interests between providers of hospital care and providers of long term care services. We study whether or not the organisation and use of resources at hospital level influence LOS for the elderly, but also whether or not resources spent by providers of long term care services are of significance. In accordance, we question whether or not formal contracts and certain coordination arrangements between hospitals and providers of care services matter for LOS. We conclude that hospital LOS for elderly patients strongly depends on the interaction with the long term care services and the organisation and resources utilized in this sector. The results point to the importance of seeing the organising and financing of hospitals and long term care in connection. We suggest that providers of hospital care and long term care are given stronger incentives to cooperate and coordinate their supply of services towards elderly patients than what is the case at present.

• Lurås, Hilde (2005). Utviklingen av antallet legebytter på fastlegens lister fra 2002 til 2004. Universitetet i Oslo. Full text in Research Archive Show summary

  Fastlegeordningen ble innført i juni 2001 over hele landet. Alle nordmenn skulle ha sin egen fastlege var målet. Denne rapporten gir en beskrivelse av de legebytter som har funnet sted i perioden 2001 til 2004. Beskrivelsene kan sees på som et tillegg til og en utvidelse av tabellene om antallet legebytter i Trygdeetatens styringsdata for FLO. Våre data om legebytter inkluderer følgende variable i perioden fra 2001 til og med 2004: • Antall nye personer på fastlegens liste (tilgang) • Antall personer som har forlatt fastlegens liste (avgang) I tillegg inkluderer dataene variable som beskriver årsaker til avgang fra en fastleges liste. Disse årsakene deles inn i: • Listepersonen er død • Listepersonens fødselsnummer er opphørt • Listepersonen har flyttet ut av kommunen • Listepersonen har flyttet til utlandet • Listepersonen har meldt seg ut av FLO • Listepersonen er overført til foreldres liste • Fastlegen har redusert sin praksis • Fastlegen har avsluttet sin praksis • Bytte av lege skyldes annen årsak • Ordinært legebytte Dataene for årene 2002 til 2004 er inkluderer antall legebytter for hele året, mens det for 2001 kun er inkludert data for perioden fra juni til desember. Vi har valgt å inkludere data for dette første halve året av FLO for å illustrere at det i denne perioden var stor aktivitet ut og inn av fastlegenes lister.

• Iversen, Tor; Godager, Geir & Lurås, Hilde (2005). Utviklingen i fastlegenes listelengder, driftsinntekter og takstbruk. Helseøkonomisk forskningsprogram ved Universitetet i Oslo. ISSN 9788277561486. Full text in Research Archive
• Godager, Geir & Lurås, Hilde (2005). I skyggen av Fastlegeordningen: Hvordan har det gått med det offentlige legearbeidet? Helseøkonomisk forskningsprogram ved Universitetet i Oslo. ISSN 9788277561516. Full text in Research Archive
• Lurås, Hilde (2004). General Practice. Four Empirical Essays on GP Behaviour and the Individuals Preferences for GPs. Universitetet i Oslo. ISSN 9788277561325. Full text in Research Archive
• Lurås, Hilde (2004). Choosing a GP. Experiences from the implementation of a listpatient system in Norway. Universitetet i Oslo. ISSN 9788277561455. Full text in Research Archive
• Lurås, Hilde (2003). Individuals' preferences for GPs. Choice analysis from the establishment of a list patient system in Norway. Universitetet i Oslo. ISSN 9788277561080. Full text in Research Archive
• Aas, Eline & Lurås, Hilde (2002). Bruk av paneldatametoder til å belyse allmennlegers henvisningsmønster. HERO. Full text in Research Archive
• Iversen, Tor & Lurås, Hilde (1999). The importance of micro-data for revealing income motivated behaviour among GPs. Universitetet i Oslo. ISSN 9788277560274. Full text in Research Archive Show summary

  The objective of this paper is to demonstrate that micro data is fundamental for the study of income motivated behaviour among general practitioners (GPs). We argue that a GP who experiences a shortage of patients in a mixed capitation and fee for service payment system, is likely to have a more service intensive practice style than his unconstrained colleagues. If he cannot have his optimal number of patients, a second best is to increase the number of services per patient if the income per time unit of providing services is greater than the marginal valuation of leisure. An empirical test requires micro data of GPs' rationing status. Data from the Norwegian capitation experiment provide us with this opportunity. We find that the effect of patient shortage (strong rationing) on a GP's income from fees per patient is positive and statistically significant. Furthermore, we find that only the municipality with the lowest GP density has a negative and statistically significant effect. If only GP density data would have been available, we might erroneously have concluded that service provision among GPs is not income motivated. The reason is that aggregate data miss the within municipality variation in the actual number of patients relative to GPs' preferred numbers. We conclude that macro data of GP density in an area are not likely to be useful in this context because the effect of better access is often not distinguishable from the effect of physician initiated services.

• Iversen, Tor & Lurås, Hilde (1998). The impact of economic motives on the provision of health services in general practice. Center for health administration, University of Oslo. Full text in Research Archive
• Iversen, Tor & Lurås, Hilde (1998). The effect of capitation on GPs' referral decisions. Center for health administration, University of Oslo. Full text in Research Archive
• Lurås, Hilde & Iversen, Tor (1996). Forsøk med fastlegeordning - økonomievaluering av forsøkskommunene. Senter for helseadministrasjon, Universitetet i Oslo. ISSN 9788277560052. Full text in Research Archive

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