Resources and organisation in primary health care are associated with HbA1c level: A nationwide study of 230 958 people with Type 2 diabetes mellitus. Issue 1 (February 2018)

• Record Type: Journal Article
• Authors: Husdal, Rebecka; Rosenblad, Andreas; Leksell, Janeth; Eliasson, Björn; Jansson, Stefan; Jerdén, Lars; Stålhammar, Jan; Steen, Lars; Wallman, Thorne; Svensson, Ann-Marie; Thors Adolfsson, Eva
• Is Part Of: Primary care diabetes. Volume 12:Issue 1(2018)
• Page Start: 23
• Page End: 33
• Publication Date: 2018-02
• Subjects: ECTS European Credit Transfer and Accumulation System -- GP general practitioner -- NDR National Diabetes Register -- PHCC primary health care centre -- RN registered nurse -- 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; HbA1c -- Organisation -- Personnel resources -- Primary health care system -- Type 2 diabetes mellitus; Diabetes -- Periodicals; 616.462
• DOI: 10.1016/j.pcd.2017.09.003
• Languages: English
• ISSNs: 1751-9918

Abstract

Highlights: Nationwide cross-sectional study in Swedish primary diabetes care. Including all primary health care centres and people with Type 2 diabetes mellitus. Linked to individual-level data regarding socio-economics and comorbidity. RNs' postgraduate education and length of visits were associated with HbA1c level. Diabetes team and group education were associated with HbA1c level. 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 = 230 958) 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) (−0.02 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 HbA1c 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 HbA1c level in people with T2DM.