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Associations between quality of work features in primary health care and glycaemic control in people with Type 2 diabetes mellitus: A nationwide survey.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical diabetology and metabolism.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical diabetology and metabolism. Dalarna Univ, Sch Educ Hlth & Social Studies, Falun, Sweden.
Sahlgrens Univ Hosp, Dept Med, Gothenburg, Sweden.
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2019 (English)In: Primary Care Diabetes, ISSN 1751-9918, E-ISSN 1878-0210, Vol. 13, no 2, p. 176-186, article id S1751-9918(18)30277-8Article in journal (Refereed) Published
Abstract [en]

Aims: To describe and analyse the associations between primary health care centres’ (PHCCs’) quality of work (QOW) and individual HbA1c levels in people with Type 2 diabetes mellitus (T2DM).

Methods: This cross-sectional study invited all 1152 Swedish PHCCs to answer a questionnaire addressing QOW conditions. Clinical, socio-economic and comorbidity data for 230,958 people with T2DM were linked to data on QOW conditions for 846 (73.4%) PHCCs.

Results: Of the participants, 56% had controlled (≤52 mmol/mol), 31.9% intermediate (53–69 mmol/mol), and 12.1% uncontrolled (≥70 mmol/mol) HbA1c. An explanatory factor analysis identified seven QOW features. The features having a call-recall system, having individualized treatment plans, PHCCs’ results always on the agenda, and having a follow-up strategy combined with taking responsibility of outcomes/results were associated with lower HbA1c levels in the controlled group (all < 0.05). For people with intermediate or uncontrolled HbA1c, having individualized treatment plans was the only QOW feature that was significantly associated with a lower HbA1c level (< 0.05).

Conclusions: This nationwide study adds important knowledge regarding associations between QOW in real life clinical practice and HbA1c levels. PHCCs’ QOW may mainly only benefit people with controlled HbA1c and more effective QOW strategies are needed to support people with uncontrolled HbA1c.

Place, publisher, year, edition, pages
2019. Vol. 13, no 2, p. 176-186, article id S1751-9918(18)30277-8
Keywords [en]
Diabetes mellitus, National survey, Primary health care, Quality of health care, Type 2
National Category
Endocrinology and Diabetes
Identifiers
URN: urn:nbn:se:uu:diva-373949DOI: 10.1016/j.pcd.2018.11.005ISI: 000462105300010PubMedID: 30545793OAI: oai:DiVA.org:uu-373949DiVA, id: diva2:1279776
Available from: 2019-01-17 Created: 2019-01-17 Last updated: 2019-04-17Bibliographically approved

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Husdal, RebeckaThors Adolfsson, EvaLeksell, JanethJerdén, LarsStålhammar, JanWallman, ThorneRosenblad, Andreas

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Husdal, RebeckaThors Adolfsson, EvaLeksell, JanethJerdén, LarsStålhammar, JanWallman, ThorneRosenblad, Andreas
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Centre for Clinical Research, County of VästmanlandClinical diabetology and metabolismCenter for Clinical Research DalarnaFamily Medicine and Preventive MedicineCentrum för klinisk forskning i Sörmland (CKFD)
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