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Register-based evaluation of primary care - Focus on chronic disease

Doctoral thesis
Authors Helena Ödesjö
Date of public defense 2019-10-11
Opponent at public defense Per Wändell
ISBN 978-91-7833-460-5 (PRINT); 978-91-7833-461-2 (PDF)
Publication year 2019
Published at Institute of Medicine, Department of Public Health and Community Medicine, Public Health Epidemiology Unit
Language en
Keywords cardiovascular diseases, diabetes, elderly, health care quality assurance, hypertension, incentive, nurses, pay för performance, potentially inappropriate medication list, primary health care, secondary prevention, statins, Sweden, quality indicators
Subject categories Public Health, Global Health, Social Medicine and Epidemiology

Abstract

Background: Options for following up primary care at the regional level have increased in Sweden, partly as a result of a national reform in 2009. In Region Västra Götaland (VGR) this was the starting point for a quality initiative with about 100 indicators, using extensive healthcare registers. Aim: To perform a register-based evaluation of aspects on chronic disease management in primary care after the primary care reform in VGR. Patients and methods: The four studies were based on individual patient data from national and regional health data and quality registers. In Studies I and II, effects of pay for performance were analysed for patients and medical data in a quality register, as well as the association of inappropriate medications with the tendency to code for medication reviews. Results: Paying for data entry led to increased coverage, completeness and reliability. Paying for medication review coding was not associated with a greater reduction of inappropriate medications at highly reimbursed primary care centres than at others. In Study III, visit patterns at primary care centres in relation to blood pressure target achievement for patients with hypertension were studied. Results: Current care for hypertension was based mainly on appointments with physicians. Patients at primary care centres with more appointments with nurses than physicians reached blood pressure targets to a greater extent. In Study IV, adherence to guidelines and the potential of improvement for lipid-lowering therapy in patients with established coronary heart disease were studied. Results: Fewer than 20% of patients reached the current target for LDL cholesterol, and estimates based on a risk model showed that improved treatment could substantially reduce the number of future cardiovascular events. Conclusion: Individual-based regional data from healthcare and quality registers offer comprehensive sources of analysis of clinical practice, effects of reimbursement systems and guideline adherence for large groups of primary care patients.

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