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01-07-2011 | Original Research

The Quality of Primary Care in a Country with Universal Health Care Coverage

Authors: Tinh-Hai Collet, MD, Sophie Salamin, BSc, Lukas Zimmerli, MD, Eve A. Kerr, MD, MPH, Carole Clair, MD, Michel Picard-Kossovsky, MD, Eric Vittinghoff, PhD, Edouard Battegay, MD, Jean-Michel Gaspoz, MD, Jacques Cornuz, MD, MPH, Nicolas Rodondi, MD, MAS

Published in: Journal of General Internal Medicine | Issue 7/2011

Abstract

BACKGROUND

Standard indicators of quality of care have been developed in the United States. Limited information exists about quality of care in countries with universal health care coverage.

OBJECTIVE

To assess the quality of preventive care and care for cardiovascular risk factors in a country with universal health care coverage.

DESIGN AND PARTICIPANTS

Retrospective cohort of a random sample of 1,002 patients aged 50–80 years followed for 2 years from all Swiss university primary care settings.

MAIN MEASURES

We used indicators derived from RAND’s Quality Assessment Tools. Each indicator was scored by dividing the number of episodes when recommended care was delivered by the number of times patients were eligible for indicators. Aggregate scores were calculated by taking into account the number of eligible patients for each indicator.

KEY RESULTS

Overall, patients (44% women) received 69% of recommended preventive care, but rates differed by indicators. Indicators assessing annual blood pressure and weight measurements (both 95%) were more likely to be met than indicators assessing smoking cessation counseling (72%), breast (40%) and colon cancer screening (35%; all p < 0.001 for comparisons with blood pressure and weight measurements). Eighty-three percent of patients received the recommended care for cardiovascular risk factors, including >75% for hypertension, dyslipidemia and diabetes. However, foot examination was performed only in 50% of patients with diabetes. Prevention indicators were more likely to be met in men (72.2% vs 65.3% in women, p < 0.001) and patients <65 years (70.1% vs 68.0% in those ≥65 years, p = 0.047).

CONCLUSIONS

Using standardized tools, these adults received 69% of recommended preventive care and 83% of care for cardiovascular risk factors in Switzerland, a country with universal coverage. Prevention indicator rates were lower for women and the elderly, and for cancer screening. Our study helps pave the way for targeted quality improvement initiatives and broader assessment of health care in Continental Europe.

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McGlynn EA, Asch SM, Adams J, et al. The quality of health care delivered to adults in the United States. N Engl J Med. 2003;348:2635–45.PubMedCrossRef

Asch SM, Kerr EA, Keesey J, et al. Who is at greatest risk for receiving poor-quality health care? N Engl J Med. 2006;354:1147–56.PubMedCrossRef

Roland M. Linking physicians' pay to the quality of care–a major experiment in the United kingdom. N Engl J Med. 2004;351:1448–54.PubMedCrossRef

Campbell SM, Ludt S, Van Lieshout J, et al. Quality indicators for the prevention and management of cardiovascular disease in primary care in nine European countries. Eur J Cardiovasc Prev Rehabil. 2008;15:509–15.PubMedCrossRef

Wolf-Maier K, Cooper RS, Kramer H, et al. Hypertension treatment and control in five European countries, Canada, and the United States. Hypertension. 2004;43:10–7.PubMedCrossRef

Wang YR, Alexander GC, Stafford RS. Outpatient hypertension treatment, treatment intensification, and control in Western Europe and the United States. Arch Intern Med. 2007;167:141–7.PubMedCrossRef

Eliasson B, Cederholm J, Nilsson P, Gudbjornsdottir S. The gap between guidelines and reality: Type 2 diabetes in a National Diabetes Register 1996–2003. Diabet Med. 2005;22:1420–6.PubMedCrossRef

Gorter K, van Bruggen R, Stolk R, Zuithoff P, Verhoeven R, Rutten G. Overall quality of diabetes care in a defined geographic region: different sides of the same story. Br J Gen Pract. 2008;58:339–45.PubMedCrossRef

Rodondi N, Cornuz J, Marques-Vidal P, et al. Aspirin use for the primary prevention of coronary heart disease: a population-based study in Switzerland. Prev Med. 2008;46:137–44.PubMedCrossRef

10.

Muntwyler J, Noseda G, Darioli R, Gruner C, Gutzwiller F, Follath F. National survey on prescription of cardiovascular drugs among outpatients with coronary artery disease in Switzerland. Swiss Med Wkly. 2003;133:88–92.PubMed

11.

Bovier PA, Sebo P, Abetel G, George F, Stalder H. Adherence to recommended standards of diabetes care by Swiss primary care physicians. Swiss Med Wkly. 2007;137:173–81.PubMed

12.

HEDIS 2007 State of Health Care Quality. 2007. (Accessed 1st December 2010, at http://www.ncqa.org/Portals/0/Publications/Resource%20Library/SOHC/SOHC_07.pdf.)

13.

Kerr EA, Smith DM, Hogan MM, et al. Building a better quality measure: are some patients with 'poor quality' actually getting good care? Med Care. 2003;41:1173–82.PubMedCrossRef

14.

Asch SM, McGlynn EA, Hogan MM, et al. Comparison of quality of care for patients in the Veterans Health Administration and patients in a national sample. Ann Intern Med. 2004;141:938–45.PubMed

15.

McGlynn EA, Kerr EA, Asch SM. New approach to assessing clinical quality of care for women: the QA Tool system. Womens Health Issues. 1999;9:184–92.PubMedCrossRef

16.

Brook RH, ed. The RAND/UCLA appropriateness method. Rockville, MD: Agency for Health Care Policy and Research; 1994.

17.

Rodondi N, Peng T, Karter AJ, et al. Therapy modifications in response to poorly controlled hypertension, dyslipidemia, and diabetes mellitus. Ann Intern Med. 2006;144:475–84.PubMed

18.

Mathers CD, Loncar D. Projections of global mortality and burden of disease from 2002 to 2030. PLoS Med. 2006;3:e442.PubMedCrossRef

19.

Kerr EA, Gerzoff RB, Krein SL, et al. Diabetes care quality in the Veterans Affairs Health Care System and commercial managed care: the TRIAD study. Ann Intern Med. 2004;141:272–81.PubMed

20.

Sim J, Wright CC. The kappa statistic in reliability studies: use, interpretation, and sample size requirements. Phys Ther. 2005;85:257–68.PubMed

21.

Reeves D, Campbell SM, Adams J, Shekelle PG, Kontopantelis E, Roland MO. Combining multiple indicators of clinical quality: an evaluation of different analytic approaches. Med Care. 2007;45:489–96.PubMedCrossRef

22.

Kerr EA, Fleming B. Making performance indicators work: experiences of US Veterans Health Administration. BMJ. 2007;335:971–3.PubMedCrossRef

23.

Bovier PA, Chamot E, Bouvier Gallacchi M, Loutan L. Importance of patients' perceptions and general practitioners' recommendations in understanding missed opportunities for immunisations in Swiss adults. Vaccine. 2001;19:4760–7.PubMedCrossRef

24.

Blank PR, Schwenkglenks M, Szucs TD. Vaccination coverage rates in eleven European countries during two consecutive influenza seasons. J Infect. 2009;58:446–58.PubMedCrossRef

25.

Calvert M, Shankar A, McManus RJ, Lester H, Freemantle N. Effect of the quality and outcomes framework on diabetes care in the United Kingdom: retrospective cohort study. BMJ. 2009;338:b1870.PubMedCrossRef

26.

Campbell SM, Reeves D, Kontopantelis E, Sibbald B, Roland M. Effects of pay for performance on the quality of primary care in England. N Engl J Med. 2009;361:368–78.PubMedCrossRef

27.

Keyhani S, Scobie JV, Hebert PL, McLaughlin MA. Gender disparities in blood pressure control and cardiovascular care in a national sample of ambulatory care visits. Hypertension. 2008;51:1149–55.PubMedCrossRef

28.

Hahn KA, Strickland PA, Hamilton JL, Scott JG, Nazareth TA, Crabtree BF. Hyperlipidemia guideline adherence and association with patient gender. J Womens Health (Larchmt). 2006;15:1009–13.CrossRef

29.

Wexler DJ, Grant RW, Meigs JB, Nathan DM, Cagliero E. Sex disparities in treatment of cardiac risk factors in patients with type 2 diabetes. Diab Care. 2005;28:514–20.CrossRef

30.

Ferrara A, Mangione CM, Kim C, et al. Sex disparities in control and treatment of modifiable cardiovascular disease risk factors among patients with diabetes: Translating Research Into Action for Diabetes (TRIAD) Study. Diab Care. 2008;31:69–74.CrossRef

31.

Opotowsky AR, McWilliams JM, Cannon CP. Gender differences in aspirin use among adults with coronary heart disease in the United States. J Gen Intern Med. 2007;22:55–61.PubMedCrossRef

32.

Di Cecco R, Patel U, Upshur RE. Is there a clinically significant gender bias in post-myocardial infarction pharmacological management in the older (>60) population of a primary care practice? BMC Fam Pract. 2002;3:8.PubMedCrossRef

33.

Holroyd-Leduc JM, Kapral MK, Austin PC, Tu JV. Sex differences and similarities in the management and outcome of stroke patients. Stroke. 2000;31:1833–7.PubMed

34.

Peabody JW, Luck J, Glassman P, Dresselhaus TR, Lee M. Comparison of vignettes, standardized patients, and chart abstraction: a prospective validation study of 3 methods for measuring quality. JAMA. 2000;283:1715–22.PubMedCrossRef

35.

Suwattee P, Lynch JC, Pendergrass ML. Quality of care for diabetic patients in a large urban public hospital. Diab Care. 2003;26:563–8.CrossRef

36.

Dresselhaus TR, Peabody JW, Luck J, Bertenthal D. An evaluation of vignettes for predicting variation in the quality of preventive care. J Gen Intern Med. 2004;19:1013–8.PubMedCrossRef

37.

Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40:373–83.PubMedCrossRef

38.

Chobanian AV, Bakris GL, Black HR, et al. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA. 2003;289:2560–72.PubMedCrossRef

39.

American Diabetes Association. Standards of medical care in diabetes-2010. Diab Care. 2010;33(Suppl 1):S11–61.CrossRef

Title: The Quality of Primary Care in a Country with Universal Health Care Coverage
Authors: Tinh-Hai Collet, MD
Sophie Salamin, BSc
Lukas Zimmerli, MD
Eve A. Kerr, MD, MPH
Carole Clair, MD
Michel Picard-Kossovsky, MD
Eric Vittinghoff, PhD
Edouard Battegay, MD
Jean-Michel Gaspoz, MD
Jacques Cornuz, MD, MPH
Nicolas Rodondi, MD, MAS
Publication date: 01-07-2011
Publisher: Springer-Verlag
Published in: Journal of General Internal Medicine / Issue 7/2011
Print ISSN: 0884-8734
Electronic ISSN: 1525-1497
DOI: https://doi.org/10.1007/s11606-011-1674-0

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OBJECTIVE

DESIGN AND PARTICIPANTS

MAIN MEASURES

KEY RESULTS

CONCLUSIONS

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