Advertisement

Resource allocation and organisational features in Swedish primary diabetes care: Changes from 2006 to 2013

Published:August 28, 2016DOI:https://doi.org/10.1016/j.pcd.2016.08.002

      Highlights

      • Examined changes in Swedish primary diabetes care between 2006 and 2013 using self-reported data.
      • List size decreased while the number of patients with type 2 diabetes (T2DM) increased.
      • RNs’ time devoted to patients with T2DM and diabetes-specific education levels increased.
      • Use of follow-up systems and medical check-ups for risk factors increased.
      • Use of group education programmes and patient participation in setting treatment targets remained low.

      Abstract

      Aims

      To compare the resource allocation and organisational features in Swedish primary diabetes care for patients with type 2 diabetes mellitus (T2DM) between 2006 and 2013.

      Methods

      Using a repeated cross-sectional study design, questionnaires covering personnel resources and organisational features for patients with T2DM in 2006 and 2013 were sent to all Swedish primary health care centres (PHCCs) during the following year. In total, 684 (74.3%) PHCCs responded in 2006 and 880 (76.4%) in 2013.

      Results

      Compared with 2006, the median list size had decreased in 2013 (p < 0.001), whereas the median number of listed patients with T2DM had increased (p < 0.001). Time devoted to patients with T2DM and diabetes-specific education levels for registered nurses (RNs) had increased, and more PHCCs had in-house psychologists (all p < 0.001). The use of follow-up systems and medical check-ups had increased (all p < 0.05). Individual counselling was more often based on patients’ needs, while arrangement of group-based education remained low. Patient participation in setting treatment targets mainly remained low.

      Conclusions

      Even though the diabetes-specific educational level among RNs increased, the arrangement of group-based education and patient participation in setting treatment targets remained low. These results are of concern and should be prioritised as key features in the care of patients with T2DM.

      Abbreviations:

      ECTS (European Credit Transfer and Accumulation System), GP (general practitioner), NDR (National Diabetes Register), PHC (primary health care), PHCC (primary health care centre), RN (registered nurse), Swed-QOP (The Swedish National Survey of the Quality and Organisation of Diabetes Care in Primary Healthcare), T2DM (type 2 diabetes mellitus), WC (waist circumference), WTE (whole time equivalent)

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Primary Care Diabetes
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Carey N.
        • Courtenay M.
        A review of the activity and effects of nurse-led care in diabetes.
        J. Clin. Nurs. 2007; 16: 296-304
        • Shaw R.J.
        • McDuffie J.R.
        • Hendrix C.C.
        • et al.
        Effects of nurse-managed protocols in the outpatient management of adults with chronic conditions: a systematic review and meta-analysis.
        Ann. Intern. Med. 2014; 161: 113-121
        • Pastors J.G.
        • Warshaw H.
        • Daly A.
        • et al.
        The evidence for the effectiveness of medical nutrition therapy in diabetes management.
        Diabetes Care. 2002; 25: 608-613
        • Ismail K.
        • Winkley K.
        • Rabe-Hesketh S.
        Systematic review and meta-analysis of randomised controlled trials of psychological interventions to improve glycaemic control in patients with type 2 diabetes.
        Lancet. 2004; 363: 1589-1597
        • Griffin S.
        Diabetes care in general practice: meta-analysis of randomised control trials.
        BMJ. 1998; 317: 390-396
        • Swedish Council on Technology Assessment in Health Care
        Patient Education in Diabetes: A Systematic Review (in Swedish), Stockholm.
        2009: 1-228 (Available at: http://www.sbu.se/contentassets/cea67d2c011443a4a914556566fb08d0/patientutbildning_vid_diabetes_fulltext.pdf (accessed 05.11.15))
        • American Diabetes Association
        Standards of medical care in diabetes – 2015 abridged for primary care providers.
        Clin. Diabetes. 2015; 33: 97-111
        • Olsson L.E.
        • Jakobsson Ung E.
        • Swedberg K.
        • Ekman I.
        Efficacy of person-centred care as an intervention in controlled trials – a systematic review.
        J. Clin. Nurs. 2013; 22: 456-465
        • International Diabetes Federation
        Diabetes in Europe: Policy Puzzle, The State We Are In.
        2014: 1-164 (Available at: https://www.idf.org/sites/default/files/youngleaders/ECD-PP4finalweb_march2015.pdf (accessed 05.11.15))
        • Worswick J.
        • Wayne S.C.
        • Bennett R.
        • et al.
        Improving quality of care for persons with diabetes: an overview of systematic reviews – what does the evidence tell us?.
        Syst. Rev. 2013; 2: 26
        • Adolfsson E.T.
        • Rosenblad A.
        • Wikblad K.
        The Swedish national survey of the quality and organization of diabetes care in primary healthcare –Swed-QOP.
        Prim. Care Diabetes. 2010; 4: 91-97
        • Mc Hugh S.
        • O’Keeffe J.
        • Fitzpatrick A.
        • et al.
        Diabetes care in Ireland: a survey of general practitioners.
        Prim. Care Diabetes. 2009; 3: 225-231
        • Jenum A.K.
        • Claudi T.
        • Cooper J.G.
        Primary care diabetes in Norway.
        Prim. Care Diabetes. 2008; 2: 203-205
        • The Swedish National Board of Health and Welfare
        National Guidelines for Diabetes Care – Support for Governance and Management, Stockholm.
        2015: 1-124 (Available at: http://www.socialstyrelsen.se/Lists/Artikelkatalog/Attachments/19803/2015-4-12.pdf (accessed 05.11.15))
        • Eliasson B.
        • Gudbjornsdottir S.
        Diabetes care – improvement through measurement.
        Diabetes Res. Clin. Pract. 2014; 106: S291-S294
        • Health Consumer Powerhouse
        Euro Diabetes Index 2014.
        Health Consumer Powerhouse, Stockholm2014: 1-72 (Available at: http://www.healthpowerhouse.com/files/EDI-2014/EDI-2014-report.pdf (accessed 05.11.15))
        • Swedish Association of Local Authorities and Regions
        Success Factors in Swedish Diabetes Care: Inspiration for the Advancement of Diabetes Care, Stockholm.
        2013: 1-68 (Available at: http://webbutik.skl.se/bilder/artiklar/pdf/5388.pdf (accessed 27.11.15))
        • The Swedish National Board of Health and Welfare
        National guidelines – Evaluation 2015 – Diabetes Care: Recommendations, Assessment and Summary (in Swedish) Stockholm.
        2015: 1-89 (Available at: http://www.socialstyrelsen.se/publikationer2015/2015-2-1 (accessed 05.11.15))
        • Swedish Parliament
        Proposition 2014/15:15: Repeal in Requirement of Health Choices System in Primary Health Care (in Swedish).
        2014: 1-17 (Available at: http://data.riksdagen.se/fil/219B147F-BAF7-412D-A4E3-5D8B406D6EE0 (accessed 05.11.15))
        • The Swedish National Board of Health and Welfare
        National Guidelines for Treatment and Care of Patients for Diabetes Mellitus, Stockholm.
        1996
        • The Swedish National Board of Health and Welfare
        National Guidelines for Treatment and Care of Patients with Diabetes Mellitus – Version for Healthcare Professionals, Stockholm.
        1999
        • The Swedish National Board of Health and Welfare
        National Guidelines for Diabetes Care 2010: Support for Governance and Management Stockholm.
        2010: 1-124
      1. Statistics Sweden. Available at: http://www.scb.se/sv_/Hitta-statistik/Statistik-efter-amne/Befolkning/Befolkningens-sammansattning/Befolkningsstatistik/25788/25795/Helarsstatistik---Riket/26046/ (accessed 12.02.16).

        • Jansson S.P.
        • Fall K.
        • Brus O.
        • et al.
        Prevalence and incidence of diabetes mellitus: a nationwide population-based pharmaco-epidemiological study in Sweden.
        Diabet. Med. 2015; 32: 1319-1328
        • Anell A.G.
        • Merkur A.H.
        • Sweden S.
        Health System Review, Health Systems in Transition.
        2012: 1-159 (Available at: http://www.euro.who.int/__data/assets/pdf_file/0008/164096/e96455.pdf (accessed 09.02.16))
        • The Swedish National Board of Health and Welfare
        The Introduction of the Healthcare Choice in Primary Care (in Swedish), Stockholm.
        2010: 1-29 (Available at: http://www.socialstyrelsen.se/publikationer2010/2010-2-10/Documents/2010-2-10.pdf (accessed 18.02.16))
        • Lisspers K.
        • Stallberg B.
        • Hasselgren M.
        • et al.
        Organisation of asthma care in primary health care in Mid-Sweden.
        Prim. Care Respir. J. 2005; 14: 147-153
        • Pierce M.
        • Agarwal G.
        • Ridout D.
        A survey of diabetes care in general practice in England and Wales.
        Br. J. Gen. Pract. 2000; 50: 542-545
        • Stewart J.
        • Kendrick D.
        Setting and negotiating targets in people with Type 2 diabetes in primary care: a cross sectional survey.
        Diabet. Med. 2005; 22: 683-687
      2. Artologik Software for the Web: Survey & Report. Available at: http://www.artologik.com/se/SurveyAndReport.aspx (accessed 12.11.15).

        • Campmans-Kuijpers M.J.
        • Baan C.A.
        • Lemmens L.C.
        • Rutten G.E.
        Diabetes quality management in Dutch care groups and outpatient clinics: a cross-sectional study.
        BMC Res. Notes. 2014; 7: 497
        • Eccles M.P.
        • Hrisos S.
        • Francis J.J.
        • et al.
        Instrument development, data collection, and characteristics of practices, staff, and measures in the Improving Quality of Care in Diabetes (iQuaD) Study.
        Implement. Sci. 2011; 6: 61
        • The Swedish Agency for Health and Care Services Analysis
        Who has Benefited from Choice in Healthcare? A Comparative Study of Three County Councils Before and After the Healthcare Choice Reform (in Swedish), Stockholm.
        2013: 1-195 (Available at: http://www.vardanalys.se/Support/In-English/Reports1/Who-is-benefiting-from-choice-in-healthcare/ (accessed 05.11.15))
        • Raaijmakers L.G.
        • Hamers F.J.
        • Martens M.K.
        • et al.
        Perceived facilitators and barriers in diabetes care: a qualitative study among health care professionals in the Netherlands.
        BMC Fam. Pract. 2013; 14: 114
        • Golden S.H.
        • Lazo M.
        • Carnethon M.
        • et al.
        Examining a bidirectional association between depressive symptoms and diabetes.
        JAMA. 2008; 299: 2751-2759
        • Stuckey H.L.
        • Mullan-Jensen C.B.
        • Reach G.
        • et al.
        Personal accounts of the negative and adaptive psychosocial experiences of people with diabetes in the second Diabetes Attitudes, Wishes and Needs (DAWN2) study.
        Diabetes Care. 2014; 37: 2466-2474
        • Holt R.I.
        • Nicolucci A.
        • Kovacs Burns K.
        • et al.
        Diabetes Attitudes, Wishes and Needs second study (DAWN2): cross-national comparisons on barriers and resources for optimal care-healthcare professional perspective.
        Diabet. Med. 2013; 30: 789-798
      3. The National Diabetes Register (NDR), A key tool for improvement (in Swedish). Available at: https://ndrstatistik.registercentrum.se (accessed 23.02.16).

        • da Vico L.
        • Monami M.
        • Biffi B.
        • et al.
        Targeting educational therapy for type 2 diabetes: identification of predictors of therapeutic success.
        Acta Diabetol. 2013; 50: 309-317
        • Hwee J.
        • Cauch-Dudek K.
        • Victor J.C.
        • et al.
        Diabetes education through group classes leads to better care and outcomes than individual counselling in adults: a population-based cohort study.
        Can. J. Public Health. 2014; 105: e192-e197
        • Hornsten A.
        • Stenlund H.
        • Lundman B.
        • Sandstrom H.
        Improvements in HbA1c remain after 5 years – a follow up of an educational intervention focusing on patients’ personal understandings of type 2 diabetes.
        Diabetes Res. Clin. Pract. 2008; 81: 50-55
        • Adolfsson E.T.
        • Smide B.
        • Gregeby E.
        • et al.
        Implementing empowerment group education in diabetes.
        Patient Educ. Couns. 2004; 53: 319-324