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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
Centre for Clinical Research Västmanland, Uppsala University, Västerås, Sweden; Department of Medical Sciences, Clinical Diabetology and Metabolism, Uppsala University, Uppsala, Sweden.
Centre for Clinical Research Västmanland, Uppsala University, Västerås, Sweden.
Department of Medical Sciences, Clinical Diabetology and Metabolism, Uppsala University, Uppsala, Sweden; School of Education, Health and Social Studies, Dalarna University, Falun, Sweden.
Department of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden.
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2019 (English)In: Primary Care Diabetes, ISSN 1751-9918, E-ISSN 1878-0210, Vol. 13, no 2, p. 176-186Article 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 (≤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).

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
Elsevier, 2019. Vol. 13, no 2, p. 176-186
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:oru:diva-70803DOI: 10.1016/j.pcd.2018.11.005ISI: 000462105300010PubMedID: 30545793Scopus ID: 2-s2.0-85057982729OAI: oai:DiVA.org:oru-70803DiVA, id: diva2:1271910
Note

Funding Agencies:

Uppsala-Örebro Regional Research Council  RFR-480801  RFR-550891  RFR-640711 

Region Västmanland  LTV-398181  LTV-472371  LTV-552001  LTV-644151 

Available from: 2018-12-18 Created: 2018-12-18 Last updated: 2019-06-18Bibliographically approved

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Jansson, Stefan P. O.

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