Stability and variation in burden of illness between primary health care centres in Stockholm, Sweden

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1 Stability and variation in burden of illness between primary health care centres in Stockholm, Sweden Authors: Peter Bolin, MSc, Head of Unit for Health Care Informatics, Stockholm County Council, Stockholm;, PhD, Center for Family and Community Medicine, Karolinska Institutet, Huddinge; Gunnar Ljunggren, PhD, Medical Advisor, Stockholm County Council, and Researcher, Karolinska Institutet, Stockholm; Anders Olsson, MSc, Health Care Division, Stockholm County Council, Stockholm; Gunnar Nilsson, Prof., Center for Family and Community Medicine, Karolinska Institutet, Huddinge.

2 Data captured and used Focusing four PHC Units Engagement by these four units Years 2006, 2007, 2008 Diagnoses from all levels of care Drugs from the National Register Relative weights for all PHC units in Stockholm CC

3 ACG trial in Stockholm CC - overall aims - to describe the potential use of the ACG system for GPs to facilitate their own analyses of PHC activities as well as a tool for quality improvement; - to investigate the potential of the ACG system to elucidate need of health care resources within PHC; - to explain to what extent the ACG could serve as a component within a future resource allocation system in Stockholm CC.

4 Choice of four PHC units A) Diagnoses registered to a high degree B) Comparison between urban and rural areas C) Variation in terms of socioeconomic areas D) Including a research declined PHC unit E) The four first units asked about participation - Gustavsberg PHC Centre - Kvartersakuten Matteus PHC Centre - Storvreten PHC Centre - TäbyCentrumDoktorn PHC Unit

5 Stockholm County Council - background Number of inhabitants t in Stockholm County 2.0 mill. Number of PHC units about 200 No gate-keeping functioning Budget year billion SEK (550 mill. USD) Share publicly/privately managed private = 58% (in numbers)

6 Gustavs- Stor- (31/12 year 2007) berg Matteus vreten Täby C D Enrolled individuals age and sex Enrolled totally (women) 49,7% 50,9% 49,9% 9% 50,9% - below 20 years 30,6% 19,0% 28,6% 26,9% - 65 years + above 11,2% 11,4% 8,8% 14,5% - 80 years + above 2,5% 3,6% 1,2% 3,5%

7 ACG-distribution (production -07) 30% 25% Gprod07 Mprod07 Sprod07 Tprod07 20% 15% 10% 5% 0%

8 Diagnoses from PHC, from outpatient care, and from all care Frekventa ACG-grupper (>2%) Gustavsberg Gust07allt Gust07egen Gust07ÖV % 5% 10% 15% 20% 25%

9 Results Different size of units (12,000-32,000 individuals enrolled) Similar patterns of morbidity burden in terms of ACGs (relative weights ) The morbidity burden was stable over time Enrolled patients cared for by their own unit varied (62% - 77%) Specialists referred to by the PHC units differed (25% - 55%) In-patient care at hospitals showed similar patterns (10% - 12% of all patients cared for)

10 Costs per drug-patient for drugs sold during the year 2008 Gust. Matt. Stor. Täby Numbers of drug"-pat.: Cost for the CC (MSEK): 58,8 8 22,9 21,4 37,4 Total cost per patient.:

11 RxMG drugs sold % 18% 16% Jämförelse läkemedelsgrupper - år 2008 (>2%) 14% 12% 10% Gust_ 08 Matt_08 Stor_08 Täby_08 8% 6% 4% 2% 0% INF GSI RES CAR PSY ALL ZZZ SKN GAS END FRE EYE

12 Discussioni The similarities in terms of co-morbidity pattern between the four units might be explained by the fact that they all were established quite a few years ago. Patients t encountering primary care units in deprived d areas are not necessarily equivalent to their co-morbidity patterns. The diagnoses registered at specialist units were not reflected by the electronic patient record at each patient s enrolled unit. Detailed ed information o about patient s use of all health care enabled ed a description of each patient s chain of care, and the discontinuity was obvious.

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