Associations between quality of work features in primary health care and glycaemic control in people with Type 2 diabetes mellitus: A nationwide survey. Issue 2 (April 2019)

• Record Type: Journal Article
• Authors: Husdal, Rebecka; Thors Adolfsson, Eva; Leksell, Janeth; Eliasson, Björn; Jansson, Stefan; Jerdén, Lars; Stålhammar, Jan; Steen, Lars; Wallman, Thorne; Svensson, Ann-Marie; Rosenblad, Andreas
• Is Part Of: Primary care diabetes. Volume 13:Issue 2(2019)
• Page Start: 176
• Page End: 186
• Publication Date: 2019-04
• Subjects: 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; Diabetes -- Periodicals; 616.462
• DOI: 10.1016/j.pcd.2018.11.005
• Languages: English
• ISSNs: 1751-9918

Abstract

Highlights: Real life clinical data are needed to understand benefits of quality of work (QOW). Examines associations between primary health care centres' QOW and HbA1c levels. An explorative factor analysis identified seven QOW features. QOW involving an individualized treatment plan decreased HbA1c level in all groups. More effective QOW strategies are needed to support people with uncontrolled HbA1c. 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.