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Jarl F, Davelid A, Hedin K, Stomby A, Petersson C. Overcoming the struggle of living with type 2 diabetes - diabetes specialist nurses' and patients' perspectives on digital interventions. BMC Health Serv Res 2023; 23:313. [PMID: 36998038 PMCID: PMC10064570 DOI: 10.1186/s12913-023-09277-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 03/11/2023] [Indexed: 04/01/2023] Open
Abstract
BACKGROUND Diabetes self-management education and support (DSMES) is a cornerstone in the treatment of type 2 diabetes mellitus (T2DM). It is unclear whether delivering DSMES as a digital health intervention (DHI) might meet the needs experienced by patients with T2DM and diabetes specialist nurses (DSN) of the primary health care system in Sweden. METHODS Fourteen patients with T2DM and four DSN participated in three separate focus groups: two groups comprised patients and one group comprised DSN. The patients discussed the questions: "What needs did you experience after your T2DM diagnosis?" and "How might these needs be met with a DHI?" The DSN discussed the questions: "What needs do you experience when treating a patient with newly diagnosed T2DM?" and "How might these needs be met with a DHI?". Furthermore, data were collected in the form of field notes from group discussions at a meeting including 18 DSNs working with T2DM in PHCCs. The discussions from focus groups were transcribed verbatim and analyzed together with the field notes from the meeting using inductive content analysis. RESULTS The analysis yielded the overall theme: "Overcoming the struggle of living with T2DM", which was summarized in two categories: "learning and being prepared" and "giving and receiving support". Important findings were that, for success, a DHI for DSMES must be integrated into routine care, provide structured, high-quality information, suggest tasks to stimulate behavioral changes, and provide feedback from the DSN to the patient. CONCLUSION This study highlighted several important aspects, from the perspectives of both the patient with T2DM and the DSN, which should be taken into consideration for the successful development and use of a DHI for DSMES.
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Affiliation(s)
- Frida Jarl
- Rosenhälsans vårdcentral, Region Jönköping County, Jönköpingsvägen 19, Huskvarna, SE-551 85, Sweden.
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
| | - Anna Davelid
- Rosenhälsans vårdcentral, Region Jönköping County, Jönköpingsvägen 19, Huskvarna, SE-551 85, Sweden
| | - Katarina Hedin
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Futurum, Region Jönköping County, Jönköping, Sweden
| | - Andreas Stomby
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Råslätts vårdcentral, Region Jönköping County, Jönköping, Sweden
| | - Christina Petersson
- Center for Learning and Innovation, Region Jönköping County, Huskvarna, Sweden
- Jönköping Academy for Improvement of Health and Welfare, Jönköping University, Jönköping, Sweden
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Husdal R, Thors Adolfsson E, Leksell J, Nordgren L. Diabetes care provided by national standards can improve patients' self-management skills: A qualitative study of how people with type 2 diabetes perceive primary diabetes care. Health Expect 2021; 24:1000-1008. [PMID: 33774899 PMCID: PMC8235889 DOI: 10.1111/hex.13247] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 03/11/2021] [Accepted: 03/16/2021] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND The increasing incidence of type 2 diabetes mellitus [T2DM] has resulted in extensive research into the characteristics of successful primary diabetes care. Even if self-management support and continuity are increasingly recognized as important, there is still a need for deeper understanding of how patients' experiences of continuity of care coincide with their needs for self-management and/or self-management support. OBJECTIVE To gain a deeper understanding of how people with T2DM perceive Swedish primary diabetes care and self-management support. METHODS This qualitative study used focus groups as the means for data collection. Participants were identified through a purposive sampling method differing in age, sex, diabetes duration and latest registered glycated haemoglobin level. Twenty-eight participants formed five focus groups. Qualitative content analysis was applied to interview transcripts. RESULTS The main theme emerging from the focus group data was that diabetes care provided by national standards improved self-management skills. Two themes that emerged from the analysis were (a) the importance of a clarification of structures and procedures in primary diabetes care and (b) health-care staff 'being there' and providing support enables trust and co-operation to enhance self-management. CONCLUSIONS Individual patients' self-management resources are strengthened if the importance of providing relational continuity, management continuity and informational continuity is considered. Patients also need assistance on 'how' self-management activities should be performed. PATIENT CONTRIBUTION Prior to the study, one pilot focus group was conducted with patients to obtain their perspectives on the content of the planned focus groups; thus, patients were involved in both planning and conduct of the study.
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Affiliation(s)
- Rebecka Husdal
- Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine, Uppsala University, Uppsala, Sweden
| | - Eva Thors Adolfsson
- Centre for Clinical Research Västmanland, Uppsala University, Västerås, Sweden
| | - Janeth Leksell
- Department of Medical Sciences, Clinical Diabetology and Metabolism, Uppsala University, Uppsala, Sweden.,School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
| | - Lena Nordgren
- Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine, Uppsala University, Uppsala, Sweden.,Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden
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Husdal R, Thors Adolfsson E, Leksell J, Eliasson B, Jansson S, Jerdén L, Stålhammar J, Steen L, Wallman T, Svensson AM, Rosenblad A. Organisation of primary diabetes care in people with type 2 diabetes in relation to all-cause mortality: A nationwide register-based cohort study. Diabetes Res Clin Pract 2020; 167:108352. [PMID: 32712123 DOI: 10.1016/j.diabres.2020.108352] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 07/03/2020] [Accepted: 07/20/2020] [Indexed: 01/03/2023]
Abstract
AIMS To examine if personnel resources and organisational features in Swedish primary health-care centres (PHCCs) are associated to all-cause mortality (ACM) in people with type 2 diabetes mellitus (T2DM). METHODS A total of 187,570 people with T2DM registered in the Swedish National Diabetes Register (NDR) during 2013 were included in this nationwide cohort study. Individual NDR data were linked to data from a questionnaire addressing personnel resources and organisational features for 787 (68%) PHCCs as well as to individual data on socio-economic status and comorbidities. Furthermore, data on ACM were obtained and followed up until 30 January 2018. Hierarchical Cox regression analyses were applied. RESULTS After a median follow-up of 4.2 years, 27,136 (14.5%) participants had died. An association was found between number of whole-time-equivalent (WTE) general practitioner's (GP's) devoted to diabetes care/500 people with T2DM and lower risk of early death (hazard ratio 0.919 [95% confidence interval 0.895-0.945] per additional WTE GP; p = 0.002). No other personnel resources or organisational features were significantly associated with ACM. CONCLUSIONS This nationwide register-based cohort study suggests that the number of WTE GPs devoted to diabetes care have an impact on the risk of early death in people with T2DM.
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Affiliation(s)
- Rebecka Husdal
- Centre for Clinical Research Västmanland, Uppsala University, Västerås, Sweden; Department of Medical Sciences, Clinical Diabetology and Metabolism, Uppsala University, Uppsala, Sweden.
| | - Eva Thors Adolfsson
- Centre for Clinical Research Västmanland, Uppsala University, Västerås, Sweden
| | - Janeth Leksell
- Department of Medical Sciences, Clinical Diabetology and Metabolism, Uppsala University, Uppsala, Sweden; School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
| | - Björn Eliasson
- Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden; National Diabetes Register, Centre of Registers, Gothenburg, Sweden
| | - Stefan Jansson
- School of Medical Sciences, University Health Care Research Centre, Örebro University, Örebro, Sweden
| | - Lars Jerdén
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden; Centre for Clinical Research Dalarna, Uppsala University, Falun, Sweden
| | - Jan Stålhammar
- Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine Section, Uppsala University, Uppsala, Sweden
| | - Lars Steen
- Drug and Therapeutics Committee, Sörmland County Council, Eskilstuna, Sweden
| | - Thorne Wallman
- Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine Section, Uppsala University, Uppsala, Sweden; Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden
| | - Ann-Marie Svensson
- Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden; National Diabetes Register, Centre of Registers, Gothenburg, Sweden
| | - Andreas Rosenblad
- Department of Medical Sciences, Clinical Diabetology and Metabolism, Uppsala University, Uppsala, Sweden; Department of Statistics, Stockholm University, Stockholm, Sweden
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Saleh Stattin N, Kane K, Stenbäck M, Wajngot A, Seijboldt K. Improving the structure of diabetes care in primary care: A pilot study. Prim Care Diabetes 2020; 14:33-39. [PMID: 31176676 DOI: 10.1016/j.pcd.2019.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 05/08/2019] [Accepted: 05/12/2019] [Indexed: 10/26/2022]
Abstract
AIM The aim of this pilot study was to determine whether glycemic control can be improved in patients with type 2 diabetes by implementing a workshop model to improve the structure of diabetes care at primary health care centers (PHCCs). METHODS The intervention consisted of 4 workshops at 12 PHCCs with HbA1c >70 mmol/mol (high HbA1c). Each PHCC could choose how many workshops they wished to attend and was to be represented by the manager, a diabetes nurse, and a GP. Participants analyzed the structure of diabetes care at their PHCC and developed an action plan to improve it. The percentage of patients with high HbA1c at baseline, 12, and 24 months was collected. Qualitative content analysis was also conducted. RESULTS All PHCCs reduced the percentage of patients with high HbA1c 12 months after the intervention, but not all maintained the reduction at 24 months. Participants experienced structuring diabetes care as central to reducing the percentage of patients with high HbA1c. Pillars of structured diabetes care included establishing routines, working in teams, and having and implementing an action plan. CONCLUSIONS Working with the structure of diabetes care improved care structure and had a positive impact on HbA1c. To sustain the positive impact, PHCCs had to set long-term goals and regularly evaluate performance.
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Affiliation(s)
- Nouha Saleh Stattin
- Academic Primary Healthcare Centre, Stockholm County Council, Solnavägen 1E (Torsplan), 113 65, Stockholm, Sweden; Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Alfred Nobels Allé 23 D2, 141 83 Huddinge, Sweden.
| | - Kimberly Kane
- Academic Primary Healthcare Centre, Stockholm County Council, Solnavägen 1E (Torsplan), 113 65, Stockholm, Sweden; Aging Research Center, Karolinska Institutet and Stockholm University, Tomtebodavägen 18 A, SE-171 77 Stockholm, Sweden
| | - Marina Stenbäck
- Academic Primary Healthcare Centre, Stockholm County Council, Solnavägen 1E (Torsplan), 113 65, Stockholm, Sweden
| | - Alexandre Wajngot
- Academic Primary Healthcare Centre, Stockholm County Council, Solnavägen 1E (Torsplan), 113 65, Stockholm, Sweden
| | - Kaija Seijboldt
- Academic Primary Healthcare Centre, Stockholm County Council, Solnavägen 1E (Torsplan), 113 65, Stockholm, Sweden
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Johansson K, Österberg SA, Leksell J, Berglund M. Supporting patients learning to live with diabetes: a phenomenological study. ACTA ACUST UNITED AC 2019; 27:697-704. [PMID: 29953270 DOI: 10.12968/bjon.2018.27.12.697] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
This article describes a study of the phenomenon of supporting patients who are learning to live with diabetes, from a diabetes specialist nurse (DSN) perspective. Guided by principles of reflective lifeworld research, data from six interviews (four in groups and two individual) with 16 DSNs were analysed. The results show that, in order to support learning, DSNs use a self-critical approach with the insight that they should not take over responsibility for their patients' diabetes. The DSNs support, encourage and challenge the patients to self-reflect and take responsibility based on patients' own goals and needs. To provide support, DSNs need to assume a tactful, critically challenging approach, dare to confront patients' fears and other emotions and have the insight to know that the responsibility for learning and integration of the condition lies with the patient. To be able to support patients in this way, it is necessary that the DSN is mentored and supported in this role.
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Affiliation(s)
- Karin Johansson
- Diabetes Specialist Nurse in Primary Health Care, Department of Administration/Primary Care, Region Kronoberg County Council, Växjö, Sweden
| | - Sofia Almerud Österberg
- Associate Professor, Department of Health and Care Sciences, Faculty of Health and Life Science, Linnaeus University, Växjö, Sweden
| | - Janeth Leksell
- Associate Professor, School of Health and Social Sciences, University Dalarna, Falun, and Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Mia Berglund
- Associate Professor, School of Health and Education, University of Skövde, Skövde, Sweden
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Husdal R, Thors Adolfsson E, Leksell J, Eliasson B, Jansson S, Jerdén L, Stålhammar J, Steen L, Wallman T, Svensson AM, Rosenblad A. Associations between quality of work features in primary health care and glycaemic control in people with Type 2 diabetes mellitus: A nationwide survey. Prim Care Diabetes 2019; 13:176-186. [PMID: 30545793 DOI: 10.1016/j.pcd.2018.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 11/02/2018] [Accepted: 11/15/2018] [Indexed: 11/28/2022]
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 (≤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.
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Affiliation(s)
- Rebecka Husdal
- Centre for Clinical Research Västmanland, Uppsala University, Västerås, Sweden; Department of Medical Sciences, Clinical Diabetology and Metabolism, Uppsala University, Uppsala, Sweden.
| | - Eva Thors Adolfsson
- Centre for Clinical Research Västmanland, Uppsala University, Västerås, Sweden
| | - Janeth Leksell
- Department of Medical Sciences, Clinical Diabetology and Metabolism, Uppsala University, Uppsala, Sweden; School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
| | - Björn Eliasson
- Department of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Stefan Jansson
- School of Medical Sciences, University Health Care Research Centre, Örebro University, Örebro, Sweden
| | - Lars Jerdén
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden; Centre for Clinical Research Dalarna, Uppsala University, Falun, Sweden
| | - Jan Stålhammar
- Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine Section, Uppsala University, Uppsala, Sweden
| | - Lars Steen
- Drug and Therapeutics Committee, Sörmland County Council, Eskilstuna, Sweden
| | - Thorne Wallman
- Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine Section, Uppsala University, Uppsala, Sweden; Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden
| | | | - Andreas Rosenblad
- Centre for Clinical Research Västmanland, Uppsala University, Västerås, Sweden
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Jendle J, Pöhlmann J, de Portu S, Smith-Palmer J, Roze S. Cost-Effectiveness Analysis of the MiniMed 670G Hybrid Closed-Loop System Versus Continuous Subcutaneous Insulin Infusion for Treatment of Type 1 Diabetes. Diabetes Technol Ther 2019; 21:110-118. [PMID: 30785311 DOI: 10.1089/dia.2018.0328] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Hybrid closed-loop (HCL) systems combine continuous glucose monitoring with continuous subcutaneous insulin infusion (CSII) to continuously self-adjust basal insulin delivery. Relative to CSII, HCL improves glycemic control and reduces the risk of hypoglycemia but has higher acquisition costs. The aim of this analysis was to assess the cost-effectiveness of the MiniMed™ 670G HCL system versus CSII in people with type 1 diabetes (T1D) in Sweden. METHODS Cost-effectiveness analysis, from a societal perspective, was performed over patient lifetimes using the IQVIA CORE Diabetes Model. Clinical data were sourced from a study comparing the MiniMed 670G system with CSII in people with T1D. Cost data, expressed in 2018 Swedish krona (SEK), were obtained from Swedish reference prices and published literature. RESULTS The MiniMed 670G system was associated with a quality-adjusted life-year (QALY) gain of 1.90 but higher overall costs versus CSII, leading to an incremental cost-effectiveness ratio (ICER) of SEK 164,236 per QALY gained. Use of the HCL system resulted in a lower cumulative incidence of diabetes-related complications. Higher HCL system acquisition costs were partially offset by reduced complication costs and productivity losses. In people with T1D poorly controlled at baseline, the MiniMed 670G system was associated with 2.25 incremental QALYs versus CSII, yielding an ICER of SEK 15,830 per QALY gained. CONCLUSIONS The MiniMed 670G system was associated with clinical benefits and quality-of-life improvements in people with T1D relative to CSII. At a willingness-to-pay threshold of SEK 300,000 per QALY gained, this HCL system likely represents a cost-effective treatment option for people with T1D in Sweden.
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Affiliation(s)
- Johan Jendle
- 1 Faculty of Medical Sciences, Örebro University, Örebro, Sweden
| | - Johannes Pöhlmann
- 2 Ossian Health Economics and Communications GmbH, Basel, Switzerland
| | - Simona de Portu
- 3 Medtronic International Trading Sàrl, Tolochenaz, Switzerland
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He J, Yin Z, Duan W, Wang Y, Wang X. Factors of hospitalization expenditure of the genitourinary system diseases in the aged based on "System of Health Account 2011" and neural network model. J Glob Health 2018; 8:020504. [PMID: 30356462 PMCID: PMC6184416 DOI: 10.7189/jogh.08.020504] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Background Hospitalization expenditure of genitourinary system diseases among the aged is often overlooked. The aim of our research is to analyze the basic situation and influencing factors of hospitalization expenditure of the genitourinary system diseases and provide better data for the health system. Methods A total of 1 377 681 patients aged 65 years and over were collected with multistage stratified cluster random sampling in 252 medical institutions in Liaoning China, and “System of Health Account 2011” (SHA2011) was conducted to analyze the expenditure of the diseases. The corresponding samples were extracted, the neural network model was utilized to fit the regression model of the diseases among the aged, and sensitivity analysis was used to rank the influencing factors. Results Total hospitalization expenditure in Liaoning was 51.286 billion yuan, and curative care expenditure of diseases of the genitourinary system was 3.350 billion yuan, accounting for 6.53%. In the neural network model, the training set of R2 was 0.71. The test set of R2 was 0.74. In the sensitivity analysis, top-three influencing factors were the length of stay, type of institutions and type of insurances; the weight was 0.28, 0.19 and 0.14, respectively. Conclusions This research used SHA2011 to grab a large amount of data and analyzed them depending upon the corresponding dimensions. The neural network can analyze the influencing factors of hospitalization expenditure of genitourinary diseases in elderly patients accurately and directly, and can clearly describe the extent of its impact by combining sensitivity analysis.
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Affiliation(s)
- Junlin He
- School of Public Health, China Medical University, Wuxi No. 2 People's Hospital Affiliated to Nanjing Medical University, Wuxi, China
| | - Zhuo Yin
- College of Metropolitan Transportation, Beijing University of Technology, Beijing, China
| | - Wenjuan Duan
- College of the Humanities and Social Sciences, China Medical University, Shenyang, China
| | | | - Xin Wang
- College of the Humanities and Social Sciences, China Medical University, School of Public Health, Xinjiang Medical University, Urumqi, China
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Husdal R, Rosenblad A, Leksell J, Eliasson B, Jansson S, Jerdén L, Stålhammar J, Steen L, Wallman T, Svensson AM, Thors Adolfsson E. Resources and organisation in primary health care are associated with HbA 1c level: A nationwide study of 230958 people with Type 2 diabetes mellitus. Prim Care Diabetes 2018; 12:23-33. [PMID: 28964673 DOI: 10.1016/j.pcd.2017.09.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 09/01/2017] [Accepted: 09/08/2017] [Indexed: 01/14/2023]
Abstract
AIMS To examine the association between personnel resources and organisational features of primary health care centres (PHCCs) and individual HbA1c level in people with Type 2 diabetes mellitus (T2DM). METHODS People with T2DM attending 846 PHCCs (n=230958) were included in this cross-sectional 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 HbA1c level were mean credits of diabetes-specific education among registered nurses (RNs) (-0.02mmol/mol for each additional credit; P<0.001) and length of regular visits to RNs (-0.19mmol/mol for each additional 15min; P<0.001). Organisational features associated with HbA1c level were having a diabetes team (-0.18mmol/mol; P<0.01) and providing group education (-0.20mmol/mol; P<0.01). CONCLUSIONS In this large sample, PHCC personnel resources and organisational features were associated with lower HbA1c level in people with T2DM.
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Affiliation(s)
- Rebecka Husdal
- Centre for Clinical Research Västmanland, Uppsala University, Västerås, Sweden; Department of Medical Sciences, Clinical Diabetology and Metabolism, Uppsala University, Uppsala, Sweden.
| | - Andreas Rosenblad
- Centre for Clinical Research Västmanland, Uppsala University, Västerås, Sweden
| | - Janeth Leksell
- Department of Medical Sciences, Clinical Diabetology and Metabolism, Uppsala University, Uppsala, Sweden
| | - Björn Eliasson
- Department of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Stefan Jansson
- School of Medical Sciences, University Health Care Research Centre, Örebro University, Örebro, Sweden
| | - Lars Jerdén
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden; Centre for Clinical Research Dalarna, Uppsala University, Falun, Sweden
| | - Jan Stålhammar
- Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine Section, Uppsala University, Uppsala, Sweden
| | - Lars Steen
- Drug and Therapeutics Committee, Sörmland County Council, Eskilstuna, Sweden
| | - Thorne Wallman
- Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine Section, Uppsala University, Uppsala, Sweden; Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden
| | | | - Eva Thors Adolfsson
- Centre for Clinical Research Västmanland, Uppsala University, Västerås, Sweden
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Duan W, Zheng A, Mu X, Li M, Liu C, Huang W, Wang X. How great is the medical burden of disease on the aged? Research based on "System of Health Account 2011". Health Qual Life Outcomes 2017; 15:134. [PMID: 28673360 PMCID: PMC5496388 DOI: 10.1186/s12955-017-0709-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Accepted: 06/26/2017] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND The aging of population and the burden of disease among the aged have become one of the hot topics in the international health, and also brought tremendous pressure in the development of health service. METHODS A total of 1,377,681 patients aged 65 years and over were collected with multistage stratified cluster random sampling in 252 medical institutions in Liaoning China, and "System of Health Account 2011" was conducted to analyze the expenditure of disease for the elderly. Influencing factors were performed using multiple stepwise regression analysis. RESULTS The curative care expenditure for the aged was 233.18 billion RMB. Most of the expenditure for the old people was in hospital. Moreover, by the disease, the highest expenditure was incurred by non-communicable diseases. The financing scheme of the aged was concentrated on social health insurance and family health expenditure. Hospitalization expenditure was significantly associated with length of stay, operation, etc. CONCLUSIONS This study intends to capture large data from various medical institutions with a new accounting system. The finding illustrates that the burden of old people is still heavy.
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Affiliation(s)
- Wenjuan Duan
- College of the Humanities and Social Sciences, China Medical University, No.77 Puhe Road, Shenyang North New Area, Shenyang, Liaoning Province 110122 People’s Republic of China
| | - Ang Zheng
- Department of Breast Surgery, the First Affiliated Hospital of China Medical University, No.155 Nanjing Road, Heping Area, Shenyang, Liaoning Province 110001 People’s Republic of China
| | - Xin Mu
- The Hospital of Stomatology, China Medical University, No.117 North of Nanjing Road, Heping Area, Shenyang, Liaoning Province 110122 People’s Republic of China
| | - Mingyang Li
- China Medical University, No.77 Puhe Road, Shenyang North New Area, Shenyang, Liaoning Province 110122 People’s Republic of China
| | - Chunli Liu
- Library of China Medical University, No.77 Puhe Road, Shenyang North New Area, Shenyang, Liaoning Province 110122 People’s Republic of China
| | - Wenzhong Huang
- College of Public Health, China Medical University, No.77 Puhe Road, Shenyang North New Area, Shenyang, Liaoning Province 110122 People’s Republic of China
| | - Xin Wang
- College of the Humanities and Social Sciences, China Medical University, No.77 Puhe Road, Shenyang North New Area, Shenyang, Liaoning Province 110122 People’s Republic of China
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