Transformation of family medicine: How is the practice of family medicine affected by increasing management control?

The past decades there has been a continuous progress towards increasing management control of primary care. Political, economic and bureaucratic management as well as the Evidence Based Medicine movement with its emphasis of clinical guidelines have impacted this development. Following this progress the Swedish Association of Local Authorities and Regions (SALAR) is working on implementing a national system for knowledge-driven management. Part of that process is implementing national clinical guidelines and patient-centered care processes for use in primary care.

How an increased management control of primary care affects the practice of family medicine in Sweden has not been thoroughly studied. International studies point towards problems with combining a holistic approach in primary care with clinical guidelines, consequences for the doctor-patient relationship and difficulties with relying on clinical guidelines in a complex reality. This project aims to increasing the knowledge on the consequences of increased management control in primary care as well as investigate the ethical dimensions of this progress.

The project is funded by the Centre for Clinical Research Sörmland in collaboration with PrimUS Sörmland, and is expected to run from 2023 to 2031.

The overall aim of this research project is to explore how an increased management control in primary care impacts the practice of family medicine. To fulfill the aim the following research questions have been formulated:

• How is the practice of primary care physicians affected by an increased management control regarding the doctor-patient relation, the professional autonomy, the balance between reflexive understanding and algorithm-based knowledge, and the working environment?
• What are the patients’ perceptions of the care provided and the sense of participation in decision-making during a consultation where the health care has a clearly predefined agenda?
• In light of these experiences, what ethical problems may occur due to increased management control of physicians, and can a continuation of this progress be ethically justified?  

A combination of empirical qualitative and mixed-method studies as well as ethical analyses will be used in the project.

• Jens Lundegård, PhD student

• Anna T. Höglund, Professor of Care Ethics and Gender Studies, Main supervisor
• Niklas Juth, professor, Professor of Medical Ethics, Co-supervisor
• Linus Johnsson, PhD, Co-supervisor