| 1. |
- Almkvist, Henrik, et al.
(författare)
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Kvalitetsbokslut minskade läkemedelskostnaderna i primärvården : Stockholms läns landstings modell för decentraliserat kostnadsansvar
- 2008
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Ingår i: Läkartidningen. - 0023-7205 .- 1652-7518. ; 105:42, s. 2930-2934
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Tidskriftsartikel (refereegranskat)abstract
- Increasing drug expenditures have resulted in various models to increase cost consciousness among prescribing doctors. In the County of Stockholm, Sweden, a model for quality assessment of prescribing was introduced in 2006. In all, 139 of 154 primary healthcare centres (PHCs) signed a contract linking extra payment to the adherence to the Drug and Therapeutics Committee guidelines if they analysed their prescribing behaviour in an annual quality report. During the first year, the adherence to guidelines increased from 80 to 83%, substantially higher than the 0-2% annual increase that had been observed previous years. The increase was similar for those PHCs not participating in the program. Qualitative analyses of all written quality reports indicate that the incentive scheme has resulted in an increased interest in quality assessment of drug prescribing. In total, 20 million SEK was spent on incentives, with estimated savings of 100 million SEK on drug expenditures.
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| 2. |
- Sarkadi, Anna, et al.
(författare)
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The influence of participant's self-perceived role on metabolic outcomes in a diabetes group education program
- 2005
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Ingår i: Patient Education and Counseling. - : Elsevier BV. - 0738-3991 .- 1873-5134. ; 58:2, s. 137-145
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Tidskriftsartikel (refereegranskat)abstract
- We investigated the demographic, biomedical, and perceptional factors influencing HbA(1c) 2 years after baseline in an educational program for persons with type 2 diabetes. Patients (N = 259) participated in a year-long group educational program led by specially trained pharmacists. There was a significant reduction of HbA(1c) (-0.15% unit; p < 0.05) on the group level after 24 months. Answers to open-ended questions on self-perceived role in diabetes management and occasions for testing blood glucose were analyzed qualitatively and used in a regression equation. Belonging to the "active" category of self-perceived role in diabetes management was associated with better outcomes compared to having a "passive" role. In addition, testing blood glucose levels for different purposes identified by the respondents was better than not to test blood glucose levels at all. The influence of these variables was striking; of the range of demographic and biomedical factors tested, only initial HbA(1c) and treatment entered the model.
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| 3. |
- Vég, Anikó, et al.
(författare)
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Self-management profiles and metabolic outcomes in type 2 diabetes
- 2006
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Ingår i: Journal of Advanced Nursing. - : Wiley. - 0309-2402 .- 1365-2648. ; 56:1, s. 44-54
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Tidskriftsartikel (refereegranskat)abstract
- Aim. This paper reports a study whose aims were (1) to examine whether it is possible to determine participants' self-management profiles using three open-ended questions about their self-perceived role in diabetes management; and (2) to analyse whether such self-management profiles have any bearing on haemoglobin A1c levels. Background. The behavioural and educational aspects of self-management in type 2 diabetes have been the topic of a number of investigations. The individual's role in maintaining health and a satisfying everyday life with chronic conditions is increasingly becoming the focus of secondary prevention. Method. Participants (n = 259) were recruited from those attending a year-long health educational programme for people with type 2 diabetes at Swedish pharmacies. A questionnaire was distributed 24 months after baseline. The health outcome, haemoglobin A1c was measured on four occasions. Three open-ended questions were used to explore self-management profiles based on perceived role, goal, and need of support in treatment. Data were collected during the period 1997–2002. Findings. The following profiles of participants emerged: Disease Manager, Compliant, and Disheartened, with no initial differences in metabolic control. However, during the programme Disease Managers achieved good glycaemic control and succeeded in maintaining the reduction in their blood glucose for a longer period than those in other categories: their haemoglobin A1c level was reduced by −0·35 at 6 months (P = 0·000), −0·30 at 12 months (P = 0·001), and −0·28 at 24 months (P = 0·001) after baseline. Compliant participants had a good everyday routine and a −0·18 reduction at 6 months (P = 0·028) but no statistically significant haemoglobin A1c level reduction later. A smaller group of people, the Disheartened, reported difficulties in living with diabetes and did not succeed in decreasing their haemoglobin A1c by statistically significant amounts. Conclusion. Healthcare professionals could use our three open-ended questions to assist in understanding people's views of their role in disease management so that health promotion and education can be tailored to individual needs.
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| 4. |
- Vég, Anikó, 1974-
(författare)
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Teaching and Learning in Type 2 Diabetes : The Importance of Self-Perceived Roles in Disease Management
- 2006
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The major part of care in type 2 diabetes is in the hands of the patient so the focus of educational interventions should be on the person behind the disease. An experience-based group education programme that actively promotes participants’ reflection and understanding has been designed and implemented in cooperation with the Swedish Pharmacy. The regression model presented in Paper I revealed the importance of self-perceived role in diabetes management. Blood glucose control two years after baseline was improved for participants who described themselves as having an active role in their treatment, compared to those taking on a passive or a compliant role. Paper II described the resulting categories from content analysis of three open-ended questions about participants’ role, goal and support needs in diabetes management. The people taking care of diabetes most effectively and needing least support were called Disease Managers; those following the health professionals’ orders and depending on regular controls were categorised as Compliant, whereas the Disheartened had difficulties in achieving good metabolic control and often described both medical and social obstacles. These three self-management profiles were strongly correlated to metabolic outcomes. In Paper III perceptions of diabetes management were reassessed: perceptions were only stable in approximately half of participants, thus providing evidence for a dynamic model of learning self-management in diabetes. The three self-management profiles still correlated with metabolic outcomes. In paper IV the long-term metabolic outcome (HbA1c) of the study population was investigated. Metabolic control was stable up to seven years following the intervention, in contrast to the metabolic deterioration often present in diabetes. The main message of this thesis is that participants’ self-perceived role had a major influence on metabolic outcomes. Assessing self-management profiles both in diabetes and possibly other chronic conditions can help health care providers to tailor their educational efforts accordingly. Furthermore, this experience-based patient education programme outside the framework of routine diabetes care has the potential to stabilise metabolic control on the long run effectively.
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| 5. |
- Vég, Anikó, et al.
(författare)
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Variation of patients’ views on Type 2 diabetes management over time
- 2007
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Ingår i: Diabetic Medicine. - : Wiley. - 0742-3071 .- 1464-5491. ; 24:4, s. 408-414
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Tidskriftsartikel (refereegranskat)abstract
- Aims The aim of the study was to examine the relationship between participants' views about their role in diabetes treatment and their glycaemic control 3–7 years after having entered an educational intervention, and to investigate whether people's attitudes towards diabetes management change over an extended period of time. Methods The present study is a long-term follow-up analysis of data collected from 193 persons with Type 2 diabetes. A qualitative content analysis of three open-ended questions about participants' self-perceived role in diabetes treatment was used. The related outcome measure was haemoglobin A1c (HbA1c). Results The way people viewed their role in diabetes management affected glycaemic control. Individuals in the Disease Manager or Compliant categories had significantly lower HbA1c compared with those in the Disheartened category. Furthermore, in people whose attitudes towards diabetes treatment was variable, weight and age influenced why participants changed their views and thus switched categories. Paradoxically, when people changed their views, this change did not produce a change in blood glucose control, which would have been expected. Conclusions From the health-care provider's perspective, it is important to know how the person with diabetes perceives his/her role in disease management and to determine if a change in perception would be followed by intervention to adjust glycaemic control. Consequently, individuals' perception of disease management should be incorporated in patient education programmes and routine diabetes care to enable customized care and prevent stagnation in negative roles.
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| 6. |
- Wettermark, B, et al.
(författare)
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Financial incentives linked to self-assessment of prescribing patterns : a new approach for quality improvement of drug prescribing in primary care.
- 2009
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Ingår i: Quality in Primary Care. - 1479-1072 .- 1479-1064. ; 17:3, s. 179-189
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND Financial incentives have been suggested to be effective in increasing the quality and efficiency of drug prescribing. Concern has been raised in relation to potential negative consequences on the quality of care. AIMS To describe and analyse the impact of an incentives model linking payment with adherence to drug and therapeutics committee (DTC) guidelines and self-reflection of prescribing pattern in a 'prescribing quality report'. METHODS The study was performed in the county of Stockholm, Sweden, with 139 (out of 154) primary healthcare centres (PHCs) participating in the project and 15 PHCs not participating. The study consisted of two parts: a quantitative observational study of prescribing patterns and a qualitative analysis of the submitted prescribing quality reports. All prescriptions issued from PHCs and dispensed at pharmacies during October to December 2005 and October to December 2006 were analysed, using adherence to the regional DTC guidelines as the main outcome measure. Adherence was assessed using the drug utilisation 90% methodology, i.e. focusing on drugs constituting 90% of the prescribed volume and the proportion of drugs included in the guidelines. The qualitative analysis focused on reports on the quality of drug prescribing submitted by each PHC in early 2007. RESULTS The 139 PHCs participating in the programme accounted for 85% of all prescriptions issued in primary care during October to December 2006. Mean adherence to guidelines increased among participating practices by 3.3 percentage units (95% confidence interval (CI) 2.9-3.7%) to 83% (82.6-83.7%) during the year. The adherence among practices not participating increased by 3.1 percentage units (95% CI 1.7-4.4%) to 78.8% (95% CI 76.7-80.9%). The higher adherence achieved during the year corresponded to savings estimated at five times greater than the cost of running the programme including the financial incentives. In addition, many areas for improving prescribing were identified, such as limiting the prescribing of drugs with uncertain safety profiles and documentation as well as reporting adverse drug reactions. CONCLUSION Although no causal effect can be attributed without a control group, we have shown the feasibility of a model linking payment to DTC adherence. This approach with its own quality assessment and goal setting offers an example to other regions and countries of how to increase the quality and efficiency of drug prescribing within limited resources.
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