| 1. |
- Dalemo, Sofia, et al.
(författare)
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Long-term follow-up of patients with elevated serum calcium concentration in Swedish primary care
- 2013
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Ingår i: Scandinavian Journal of Primary Health Care. - : Informa UK Limited. - 0281-3432 .- 1502-7724. ; 31:4, s. 248-254
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Tidskriftsartikel (refereegranskat)abstract
- Objective. To follow up patients with elevated calcium concentrations after 10 years. Design. Longitudinal, using medical records, questionnaires, and clinical investigation. Setting. Primary care in Tibro, Sweden, 2008–2010. Subjects. 127 patents with elevated calcium concentrations and 254 patients with normal calcium concentrations from the local community, attending the health care centre. Main outcome measures. Diagnoses and mortality in patients with elevated calcium concentrations in 1995–2000, compared with patients with normal calcium concentrations and the background population. Results. The proportion of patients for whom no underlying cause was detected decreased from 55% at baseline to 12% at follow-up. Primary hyperparathyroidism was most common in women, 23% at baseline and 36% at follow-up, and the cancer prevalence increased from 5% to 12% in patients with elevated calcium concentration. Mortality tended to be higher in men with elevated calcium concentrations compared with men with normal calcium concentrations, and was significantly higher than in the background population (SMR 2.3, 95% CI 1.3–3.8). Cancer mortality was significantly increased in men (p = 0.039). Low calcium concentrations were also associated with higher mortality (p = 0.004), compared with patients with normal calcium concentrations. Conclusion. This study underscores the importance of investigating patients with increased calcium concentrations suggesting that most of these patients – 88% in our study – will turn out to have an underlying disease associated with hypercalcaemia during a 10-year follow-up period. Elevated calcium concentrations had a different disease pattern in men and women, with men showing increased cancer mortality in this study. Read More: http://informahealthcare.com/doi/abs/10.3109/02813432.2013.861152
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| 2. |
- Dalemo, Sofia, et al.
(författare)
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Quality of life and health care consumption in primary care patients with elevated serum calcium concentrations in - a prospective, case control, study
- 2014
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Ingår i: BMC Family Practice. - : Springer Science and Business Media LLC. - 1471-2296. ; 15:84
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Tidskriftsartikel (refereegranskat)abstract
- Abstract Background Patients with elevated calcium concentrations have an increased morbidity due to various underlying illnesses. However, there is a lack of studies of quality of life and health care consumption in patients with hypercalcaemia per se. The study aims to investigate quality of life and health care consumption, as measured by, sick leave, drug prescriptions and the number of visits and admissions to health care centres and hospitals, in primary care patients with elevated calcium concentrations. Methods A prospective, case control, study in primary care centre, in Sweden. Patients with elevated, (n = 127, 28 men), and normal calcium concentrations, (n = 254, 56 men), mean age 61.4 year, were recruited in the study and followed during 10 years. Eighty-six percent of those alive at the time of follow up participated in a follow up visit. The study participants completed a quality of life survey, SF-36, which also were compared with the Swedish SF-36 national normative database. Results Patients with elevated calcium concentrations had significantly lower quality of life both compared with the control group (patients with normal calcium concentrations) and compared with age and gender-matched reference material from the Swedish SF-36 national normative database. The group with elevated calcium concentrations had significantly more hospitalisations (p = 0.017), subsequently cancer diagnoses (p < 0.003), sick leave (p = 0.007) and medication (p = 0.002) compared with patients with normal calcium concentrations. Men with elevated calcium concentrations had more contacts with the psychosocial team (p = 0.02) at the health care centre. Conclusions Elevated calcium concentrations are associated with significantly reduced quality of life and increased health care consumption and should therefore be an important warning flag that should alert the physician to further investigate and care for the patient. This is the first study in this field and the results need to be confirmed in further studies.
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| 3. |
- Dalemo, Sofia, et al.
(författare)
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Variation in plasma calcium analysis in primary care in Sweden--a multilevel analysis.
- 2010
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Ingår i: BMC family practice. - : Springer Science and Business Media LLC. - 1471-2296. ; 11
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Tidskriftsartikel (refereegranskat)abstract
- Primary hyperparathyroidism (pHPT) is a common disease that often remains undetected and causes severe disturbance especially in postmenopausal women. Therefore, national recommendations promoting early pHPT detection by plasma calcium (P-Ca) have been issued in Sweden. In this study we aimed to investigate variation of P-Ca analysis between physicians and health care centres (HCCs) in primary care in county of Skaraborg, Sweden.
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| 4. |
- Hjerpe, Per, et al.
(författare)
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Increased registration of hypertension and cancer diagnoses after the introduction of a new reimbursement system
- 2012
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Ingår i: Scandinavian Journal of Primary Health Care. - : Informa UK Limited. - 0281-3432 .- 1502-7724. ; 30:4, s. 222-228
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Tidskriftsartikel (refereegranskat)abstract
- Objective. To investigate the impact on ICD coding behaviour of a new case-mix reimbursement system based on coded patient diagnoses. The main hypothesis was that after the introduction of the new system the coding of chronic diseases like hypertension and cancer would increase and the variance in propensity for coding would decrease on both physician and health care centre (HCC) levels. Design. Cross-sectional multilevel logistic regression analyses were performed in periods covering the time before and after the introduction of the new reimbursement system. Setting. Skaraborg primary care, Sweden. Subjects. All patients (n = 76 546 to 79 826) 50 years of age and older visiting 468 to 627 physicians at the 22 public HCCs in five consecutive time periods of one year each. Main outcome measures. Registered codes for hypertension and cancer diseases in Skaraborg primary care database (SPCD). Results. After the introduction of the new reimbursement system the adjusted prevalence of hypertension and cancer in SPCD increased from 17.4% to 32.2% and from 0.79% to 2.32%, respectively, probably partly due to an increased diagnosis coding of indirect patient contacts. The total variance in the propensity for coding declined simultaneously at the physician level for both diagnosis groups. Conclusions. Changes in the healthcare reimbursement system may directly influence the contents of a research database that retrieves data from clinical practice. This should be taken into account when using such a database for research purposes, and the data should be validated for each diagnosis.
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| 5. |
- Hjerpe, Per
(författare)
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Investigating practice variation in a changing primary care. A multilevel perspective on The Skaraborg Primary Care Database
- 2011
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background and Aims: Differences in the clinical care of patients have been explained through the concept of practice variation, that is, the occurrence of established local medical procedures that varies between geographic areas. The primary measures introduced to eliminate undesirable differences in medical care are the introduction of medical guidelines and economical incentives that rewards the desired behaviour. Practice variation in primary care can be seen on different hierarchically organised levels (e.g. patient, physician, health care center (HCC)) and Multilevel Regression analysis techniques (MLRA) offer a suitable tool to analyse these kinds of data. Data extracted from computerised medical records are ideal for studying practice variation as they often comprise information from several levels. In the region of Skaraborg in Sweden a new database, the Skaraborg Primary care database (SPCD), comprising information extracted form the computerised medical records of all public health care centres has recently been established. The overall aims of this thesis were to examine the usefulness and quality of the SPCD database for research and to study practice variation in some important areas such as diagnosis registration, laboratory analysis ordering and prescriptions. Furthermore, the influence of changes in the economic incentives on physician’s clinical behaviour was investigated. Material and Methods: In all studies data from the SPCD comprising data on individual patients from all public health care centres was used. The registration of diagnoses in the SPCD was validated by comparing the occurrence of recorded diagnosis in the diagnosis register of the database with the free text part of the patient medical records for a randomly selected sample of patients. Multilevel logistic regression analysis was used to investigate practice variation in prescribing and laboratory test ordering, focusing on measures of both frequency and variance. The effects of changes in economic incentives for diagnosis coding and prescribing were examined by comparing multilevel analysis results before and after implementation of the economic incentives. Results and Conclusions: The frequency of registration of ICD codes varied between diagnoses but also between physicians and HCCs. Different diagnoses need to be validated separately. The occurrence of practice variation was demonstrated both in laboratory test ordering where the physician level was the most important level and in prescribing where physician and HCC levels were equally important in explaining the observed variation. A positive effect in adherence to prescribing guidelines was demonstrated after the introduction of a decentralised drug budget. The introduction of a strong economic incentive for ICD coding showed the expected rise in coding rates and decline in variation, directly affecting the diagnoses register of the research database. Changes in the healthcare process will have a direct impact on the research database. Knowledge about the local health care processes is essential when interpreting database data. The SPCD seems as a good complement to previously established databases and quality registers, offering new possibilities when studying primary care.
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| 6. |
- Hjerpe, Per, et al.
(författare)
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Understanding adherence to therapeutic guidelines: a multilevel analysis of statin prescription in the Skaraborg Primary Care Database
- 2011
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Ingår i: European Journal of Clinical Pharmacology. - : Springer Science and Business Media LLC. - 1432-1041 .- 0031-6970. ; 67:4, s. 415-423
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Tidskriftsartikel (refereegranskat)abstract
- In Skaraborg, Sweden, the economic responsibility for tax-financed prescription drug costs was transferred from the regional administrative level to the local level (health care centre; HCC) in 2003. The aim of this study was to investigate the impact of this decentralization of economic responsibility on adherence to guidelines for prescribing lipid-lowering drugs. Data from all 24 public HCCs in Skaraborg on prescriptions for lipid-lowering drugs during 2003 and 2005 were extracted from the Skaraborg Primary Care Database (SPCD). Multilevel regression analysis (MLRA) was used to disentangle the variances at different levels of data (patient, physician, HCC). The outcome variable on the patient level was the prescription of the recommended statin (yes/no). Sex and age of the patients and sex, age and occupational status of the physician were included as fixed effects. The variance was expressed as the median odds ratio (MOR). The prevalence of adherence to guidelines for the prescription of statins increased from 77% in 2003 to 84% in 2005. The MLRA showed that in 2003 the variance was equally distributed between the HCC and physician levels (MORHCC2003 = 1.89 vs. MORPHYSICIAN2003 = 1.88). The variance between physicians and between HCCs decreased considerably between 2003 and 2005. The inclusion of individual and physician characteristics did not explain any of the remaining variance. The decentralized budget appears to have increased adherence to guidelines and reduced inefficient variation in prescribing.
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| 7. |
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| 8. |
- Hjerpe, Per, et al.
(författare)
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Validity of registration of ICD codes and prescriptions in a research database in Swedish primary care: a cross-sectional study in Skaraborg primary care database
- 2010
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Ingår i: BMC Medical Informatics and Decision Making. - : Springer Science and Business Media LLC. - 1472-6947. ; 10
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Tidskriftsartikel (refereegranskat)abstract
- Background: In recent years, several primary care databases recording information from computerized medical records have been established and used for quality assessment of medical care and research. However, to be useful for research purposes, the data generated routinely from every day practice require registration of high quality. In this study we aimed to investigate (i) the frequency and validity of ICD code and drug prescription registration in the new Skaraborg primary care database (SPCD) and (ii) to investigate the sources of variation in this registration. Methods: SPCD contains anonymous electronic medical records (ProfDoc III) automatically retrieved from all 24 public health care centres (HCC) in Skaraborg, Sweden. The frequencies of ICD code registration for the selected diagnoses diabetes mellitus, hypertension and chronic cardiovascular disease and the relevant drug prescriptions in the time period between May 2002 and October 2003 were analysed. The validity of data registration in the SPCD was assessed in a random sample of 50 medical records from each HCC (n = 1200 records) using the medical record text as gold standard. The variance of ICD code registration was studied with multi-level logistic regression analysis and expressed as median odds ratio (MOR). Results: For diabetes mellitus and hypertension ICD codes were registered in 80-90% of cases, while for congestive heart failure and ischemic heart disease ICD codes were registered more seldom (60-70%). Drug prescription registration was overall high (88%). A correlation between the frequency of ICD coded visits and the sensitivity of the ICD code registration was found for hypertension and congestive heart failure but not for diabetes or ischemic heart disease. The frequency of ICD code registration varied from 42 to 90% between HCCs, and the greatest variation was found at the physician level (MORPHYSICIAN = 4.2 and MORHCC = 2.3). Conclusions: Since the frequency of ICD code registration varies between different diagnoses, each diagnosis must be separately validated. Improved frequency and quality of ICD code registration might be achieved by interventions directed towards the physicians where the greatest amount of variation was found.
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| 9. |
- Ljungman, Charlotta, 1977, et al.
(författare)
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Gender differences in antihypertensive drug treatment: results from the Swedish Primary Care Cardiovascular Database (SPCCD).
- 2014
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Ingår i: Journal of the American Society of Hypertension : JASH. - : Elsevier BV. - 1878-7436 .- 1933-1711. ; 8:12, s. 882-90
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Tidskriftsartikel (refereegranskat)abstract
- There are gender differences in antihypertensive treatment. This study aimed to investigate if gender differences in treatment could be explained by comorbidities. In addition, we aimed to study whether blood pressure control is different in women and men, and whether women interrupt treatment more often with angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) compared with men.This cohort study within the Swedish Primary Care Cardiovascular Database included 40,825 patients with hypertension attending primary health care from 2007 to 2008. Cardiovascular comorbidities, with the exception of heart failure, were more common in men. Women were more often treated with diuretics, and men with ACEI, as were hypertensive patients with diabetes. Comorbidities could not entirely explain gender differences in antihypertensive treatment in a regression model. Women had higher systolic and lower diastolic blood pressure; this was also true in subgroups with cardiovascular comorbidity. Men more often than women were prescribed ACEIs/ARBs and interrupted treatment. Women and men are treated with different antihypertensive drugs, and this is not fully explained by differences in comorbidities. Women have higher systolic blood pressures, irrespective of comorbidity. Men have interrupted treatment more often with ACEIs/ARBs. These gender differences could affect outcome and warrant further investigation.
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| 10. |
- Vikström, Anna, et al.
(författare)
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Coding of procedures documented by general practitioners in Swedish primary care - an explorative study using two procedure coding systems.
- 2012
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Ingår i: BMC family practice. - : Springer Science and Business Media LLC. - 1471-2296. ; 13:1
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Tidskriftsartikel (refereegranskat)abstract
- ABSTRACT: BACKGROUND: Procedures documented by general practitioners in primary care have not been studied in relation to procedure coding systems. We aimed to describe procedures documented by Swedish general practitioners in electronic patient records and to compare them to the Swedish Classification of Health Interventions (KVA) and SNOMED CT. METHODS: Procedures in 200 record entries were identified, coded, assessed in relation to two procedure coding systems and analysed. RESULTS: 417 procedures found in the 200 electronic patient record entries were coded with 36 different Classification of Health Interventions categories and 148 different SNOMED CT concepts. 22.8% of the procedures could not be coded with any Classification of Health Interventions category and 4.3% could not be coded with any SNOMED CT concept. 206 procedure-concept/category pairs were assessed as a complete match in SNOMED CT compared to 10 in the Classification of Health Interventions. CONCLUSIONS: Procedures documented by general practitioners were present in nearly all electronic patient record entries. Almost all procedures could be coded using SNOMED-CT. Classification of Health Interventions covered the procedures to a lesser extent and with a much lower degree of concordance. SNOMED CT is a more flexible terminology system that can be used for different purposes for procedure coding in primary care.
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