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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.
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(English)In: Primary Care Diabetes, ISSN 1751-9918, E-ISSN 1878-0210Article in journal (Refereed) Epub ahead of print
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:uu:diva-371494OAI: oai:DiVA.org:uu-371494DiVA, id: diva2:1273448
Available from: 2018-12-21 Created: 2018-12-21 Last updated: 2018-12-21
In thesis
1. Key Features for Successful Swedish Primary Diabetes Care – Reality or Fiction?: Nationwide studies of longitudinal follow-up, HbA1c levels and all-cause mortality in an organizational context
Open this publication in new window or tab >>Key Features for Successful Swedish Primary Diabetes Care – Reality or Fiction?: Nationwide studies of longitudinal follow-up, HbA1c levels and all-cause mortality in an organizational context
2019 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Aims To extend knowledge about the changes in Swedish primary diabetes care from 2006 to 2013 and investigate associations of personnel resources, organizational features and quality-of-work conditions of primary health-care centres (PHCCs) with individual HbA1c levels and all-cause mortality in people with type 2 diabetes mellitus (T2DM).

Methods Information about organizational features, personnel resources and quality-of-work conditions were collected from responses of PHCC managers to the Swedish National Survey of the Quality and Organisation of Diabetes Care in Primary HealthCare (Swed-QOP) questionnaire. The longitudinal cross-sectional study included 74.3% and 76.4% of PHCCs in 2006 and 2013, respectively. Individual clinical data for 230,958 people with T2DM obtained from the Swedish National Diabetes Register were linked to the data from the Swed-QOP questionnaire. Individual data were linked to socio-economic and comorbidity data. All-cause mortality was followed up for a median of 4.2 years for 187,570 people with T2DM.

Results The longitudinal follow-up study showed a decreased median PHCC list size but an increased median number of people with T2DM. The mean European Credit Transfer and Accumulation System (ECTS) credits in diabetes-specific education for registered nurses (RNs) increased. The number of PHCCs providing group education programs and involving the patient in goal setting remained low (I). PHCCs having diabetes teams and group education programs were associated with decreased HbA1c levels. Using call-recall system to general practitioners (GPs) was associated with increased HbA1c levels (II). Seven quality-of-work features were identified, of which Individualized treatment was associated with decreased HbA1c levels in people with controlled (≤ 52 mmol/mol), intermediate (53–69 mmol/mol) and uncontrolled (≥ 70 mmol/mol) HbA1c (III). GP staffing was associated with a decreased risk of early death and the mean ECTS credits in diabetes-specific and pedagogical education of RNs was associated with a decreased risk of early death in people aged ≥ 55 years and in men, respectively (IV).

Conclusion This thesis adds to previous work on significant but less pronounced key features for successful organization of primary diabetes care, and indicates that the complexity of diabetes disease makes it difficult to identify success factors applicable to all people living with T2DM.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2019. p. 91
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1529
Keywords
Epidemiology, Organization, Personnel resources, Primary health-care, Type 2 diabetes mellitus
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-371496 (URN)978-91-513-0548-6 (ISBN)
Public defence
2019-02-22, Samlingssalen, Psykiatricentrum ingång 29, Västmanlands sjukhus Västerås, Västerås, 13:15 (Swedish)
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Supervisors
Available from: 2019-02-01 Created: 2018-12-21 Last updated: 2019-02-18

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Husdal, RebeckaLeksell, JanethStålhammar, JanWallman, Thorne

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Husdal, RebeckaLeksell, JanethStålhammar, JanWallman, ThorneRosenblad, Andreas
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Centre for Clinical Research, County of VästmanlandClinical diabetology and metabolismFamily Medicine and Preventive MedicineCentrum för klinisk forskning i Sörmland (CKFD)
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