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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
Authors:Rebecka Husdal  Eva Thors Adolfsson  Janeth Leksell  Björn Eliasson  Stefan Jansson  Lars Jerdén  Jan Stålhammar  Lars Steen  Thorne Wallman  Ann-Marie Svensson  Andreas Rosenblad
Affiliation:1. Centre for Clinical Research Västmanland, Uppsala University, Västerås, Sweden;2. Department of Medical Sciences, Clinical Diabetology and Metabolism, Uppsala University, Uppsala, Sweden;3. School of Education, Health and Social Studies, Dalarna University, Falun, Sweden;4. Department of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden;5. School of Medical Sciences, University Health Care Research Centre, Örebro University, Örebro, Sweden;6. Centre for Clinical Research Dalarna, Uppsala University, Falun, Sweden;7. Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine Section, Uppsala University, Uppsala, Sweden;8. Drug and Therapeutics Committee, Sörmland County Council, Eskilstuna, Sweden;9. Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden;10. National Diabetes Register, Centre of Registers, Gothenburg, Sweden
Abstract:

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 (≤52 mmol/mol), 31.9% intermediate (53–69 mmol/mol), and 12.1% uncontrolled (≥70 mmol/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.
Keywords:CI  confidence interval  EFA  exploratory factor analysis  GEE  generalized estimating equations  GP  general practitioner  NDR  National Diabetes Register  OHA  oral hypoglycaemic agents  PHC  primary health care  PHCC  primary health care centre  RN  registered nurse  SALAR  Swedish Association of Local Authorities and Regions  QOW  quality of work  Swed–QOP  Swedish National Survey of the Quality and Organisation of Diabetes Care in Primary Healthcare  T2DM  Type 2 diabetes mellitus  WTE  whole time equivalent  Diabetes mellitus  Type 2  National survey  Primary health care  Quality of health care
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