Resources and organisation in primary health care are associated with HbA_1c level: A nationwide study of 230958 people with Type 2 diabetes mellitus.

Abstract

To examine the association between personnel resources and organisational features of primary health care centres (PHCCs) and individual HbA_1c level in people with Type 2 diabetes mellitus (T2DM). People with T2DM attending 846 PHCCs (n=230958) 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. After adjusting for PHCC- and individual-level confounding factors, personnel resources associated with lower individual HbA_1c level were mean credits of diabetes-specific education among registered nurses (RNs) (-0.02mmol/mol for each additional credit; P<0.001) and length of regular visits to RNs (-0.19mmol/mol for each additional 15min; P<0.001). Organisational features associated with HbA_1c level were having a diabetes team (-0.18mmol/mol; P<0.01) and providing group education (-0.20mmol/mol; P<0.01). In this large sample, PHCC personnel resources and organisational features were associated with lower HbA_1c level in people with T2DM.