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

  • Original Research
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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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References

  1. 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.

    Article  PubMed  Google Scholar 

  2. 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.

    Article  PubMed  CAS  Google Scholar 

  3. 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.

    Article  PubMed  CAS  Google Scholar 

  4. 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.

    Article  PubMed  Google Scholar 

  5. 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.

    Article  PubMed  CAS  Google Scholar 

  6. 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.

    Article  PubMed  Google Scholar 

  7. 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.

    Article  PubMed  CAS  Google Scholar 

  8. 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.

    Article  PubMed  Google Scholar 

  9. 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.

    Article  PubMed  Google Scholar 

  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  Google Scholar 

  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  CAS  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

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

    Google Scholar 

  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  Google Scholar 

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

    Article  PubMed  Google Scholar 

  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  Google Scholar 

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

    PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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  CAS  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

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

    Article  Google Scholar 

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Acknowledgements

Research funding for the collection and analysis of these data was provided by an investigator-initiated unrestricted grant from Pfizer (Switzerland), but had no role in the study design, the choice of statistical analyses, or the preparation of the manuscript. Tinh-Hai Collet’s work was partially supported by a grant from the Swiss Heart Foundation. An oral presentation of preliminary results was given at the 32nd SGIM Annual Meeting, May 2009, Miami, FL, under the title “The quality of preventive care delivered to adults in European university primary care settings.”

Potential Conflicts of Interest

An investigator-initiated grant from Pfizer (Switzerland) was provided only for data collection and analysis, but had no role in the study design, the choice of statistical analyses, or the preparation of the manuscript.

Author information

Authors and Affiliations

  1. Department of Ambulatory Care and Community Medicine, University of Lausanne, Bugnon 44, 1011, Lausanne, Switzerland

    Tinh-Hai Collet MD, Sophie Salamin BSc, Carole Clair MD, Jacques Cornuz MD, MPH & Nicolas Rodondi MD, MAS

  2. Division of Internal Medicine, University Hospital of Zurich, Zurich, Switzerland

    Lukas Zimmerli MD & Edouard Battegay MD

  3. Medical Outpatient Department/Ambulatory Internal Medicine, University Hospital Basel, Basel, Switzerland

    Lukas Zimmerli MD & Edouard Battegay MD

  4. Veterans Affairs Center for Clinical Management Research, HSR&D Center of Excellence; Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA

    Eve A. Kerr MD, MPH

  5. Department of Community Medicine and Primary Care, University Hospitals of Geneva, and Faculty of Medicine, Geneva, Switzerland

    Michel Picard-Kossovsky MD & Jean-Michel Gaspoz MD

  6. Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA

    Eric Vittinghoff PhD

Authors
  1. Tinh-Hai Collet MD
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  2. Sophie Salamin BSc
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  3. Lukas Zimmerli MD
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  11. Nicolas Rodondi MD, MAS
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Corresponding author

Correspondence to Nicolas Rodondi MD, MAS.

Additional information

Tinh-Hai Collet and Sophie Salamin contributed equally to the article.

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Collet, TH., Salamin, S., Zimmerli, L. et al. The Quality of Primary Care in a Country with Universal Health Care Coverage. J GEN INTERN MED 26, 724–730 (2011). https://doi.org/10.1007/s11606-011-1674-0

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  • DOI: https://doi.org/10.1007/s11606-011-1674-0

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