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- Husdal, Rebecka, et al.
(författare)
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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.
- 2019
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Ingår i: Primary care diabetes. - : Elsevier BV. - 1878-0210 .- 1751-9918. ; 13:2, s. 176-186
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Tidskriftsartikel (refereegranskat)abstract
- 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).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.Of the participants, 56% had controlled (≤52mmol/mol), 31.9% intermediate (53-69mmol/mol), and 12.1% uncontrolled (≥70mmol/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 p<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 (p<0.05).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.
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| 2. |
- Husdal, Rebecka, et al.
(författare)
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Resource allocation and organisational features in Swedish primary diabetes care : Changes from 2006 to 2013
- 2017
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Ingår i: Primary Care Diabetes. - : Elsevier. - 1751-9918 .- 1878-0210. ; 11:1, s. 20-28
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Tidskriftsartikel (refereegranskat)abstract
- Aims: To compare the resource allocation and organisational features in Swedish primary diabetes care for patients with type 2 diabetes mellitus (T2DM) between 2006 and 2013.Methods: Using a repeated cross-sectional study design, questionnaires covering personnel resources and organisational features for patients with T2DM in 2006 and 2013 were sent to all Swedish primary health care centres (PHCCs) during the following year. In total, 684 (74.3%) PHCCs responded in 2006 and 880 (76.4%) in 2013.Results: Compared with 2006, the median list size had decreased in 2013 (p<0.001), whereas the median number of listed patients with T2DM had increased (p<0.001). Time devoted to patients with T2DM and diabetes-specific education levels for registered nurses (RNs) had increased, and more PHCCs had in-house psychologists (all p<0.001). The use of follow-up systems and medical check-ups had increased (all p<0.05). Individual counselling was more often based on patients' needs, while arrangement of group-based education remained low. Patient participation in setting treatment targets mainly remained low.Conclusions: Even though the diabetes-specific educational level among RNs increased, the arrangement of group-based education and patient participation in setting treatment targets remained low. These results are of concern and should be prioritised as key features in the care of patients with T2DM. (C) 2016 Primary Care Diabetes Europe. Published by Elsevier Ltd. All rights reserved.
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| 3. |
- Husdal, Rebecka, et al.
(författare)
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Resources and organisation in primary health care are associated with HbA(1c) level : A nationwide study of 230 958 people with Type 2 diabetes mellitus
- 2018
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Ingår i: Primary Care Diabetes. - : Elsevier. - 1751-9918 .- 1878-0210. ; 12:1, s. 23-33
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Tidskriftsartikel (refereegranskat)abstract
- Aims: To examine the association between personnel resources and organisational features of primary health care centres (PHCCs) and individual HbAic level in people with Type 2 diabetes mellitus (T2DM).Methods: People with T2DM attending 846 PHCCs (n =230 958) were included in this crosssectional study based on PHCC-level data from a questionnaire sent to PHCCs in 2013 and individual-level clinical data from 2013 for people with T2DM reported in the Swedish National Diabetes Register, linked to individual-level data on socio-economic status and comorbidities. Data were analysed using a generalized estimating equations linear regression models.Results: After adjusting for PHCC- and individual-level confounding factors, personnel resources associated with lower individual HbAi, level were mean credits of diabetes specific education among registered nurses (RNs) (-0.02 mmol/mol for each additional credit; P < 0.001) and length of regular visits to RNs (-0.19 mmol/mol for each additional 15 min; P < 0.001). Organisational features associated with HbAie level were having a diabetes team (-0.18 mmol/mol; P <0.01) and providing group education (-0.20 mmol/mol; P < 0.01).Conclusions: In this large sample, PHCC personnel resources and organisational features were associated with lower HbA(1c), level in people with T2DM.
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