DIABETES CARE Diabetes is a chronic condition that is associated with increased risk of other diseases. An estimated 450 000 Swedes have diabetes. Some 85–90 per cent of them have adult (type 2) diabetes. The rest have juvenile (type 1) diabetes. For most persons with diabetes, primary care constitutes their regular mode of contact with the healthcare system. Other patients, particularly those with type 1 diabetes, generally have contact with medical clinics at hospitals. Among the potential complications of diabetes are myocardial infarction, angina pectoris, ischaemic stroke, hypertension, lower limb ischaemia and retinopathy. There is strong scientific evidence that diabetic complications can be delayed or prevented, preferably by broadly addressing the risk factors that correlate most strongly with their development. There are a number of well-established quality indicators, along with associated treatment goals, that reflect risk factors. Among them are blood pressure, cholesterol and long-term blood glucose (HbA1c) levels, as well as smoking and obesity. Seven diabetes care indicators are presented. Six of them are based on data from the Swedish National Diabetes Register or the Quality Register for Children and Adolescents with Diabetes, which is part of it. One indicator proceeds from data in the National Patient Register of the Swedish National Board of Health and Welfare, which issued new national guidelines for diabetes care in 2010. An integral part of the effort was to develop quality indicators that could support systematic followup. The indicators presented here are fully consistent with the recommendations of the guidelines and the indicators included in the board’s evaluation of diabetes care published in January 2012. Three indicators concern treatment goals for blood glucose, blood pressure and lipid levels respectively in primary care, and one indicator concerns fulfilment of blood glucose goals among children and adolescents with diabetes. Two indicators are shown for persons with type 1 diabetes, cared for in hospital outpatients clinics and involve treatment goals for blood pressure and glucose levels. Another indicator covers amputations among people with diabetes. The National Diabetes Register collects data about diabetes care from both medical and primary care clinics. The register estimates the national participation rate for 2011 at 85 per cent, with relatively wide variations between counties. The rate was very good at hospitals and has improved significantly in recent years when it comes to primary care. The diagrams show estimated participation rate by county. Whether reported results are representative of diabetes care in general is less certain when participation rates are low.
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QUALITY AND EFFICIENCY IN SWEDISH HEALTH CARE 2012