The effect of the integration of health services on health care usage among patients with type 2 diabetes in North Karelia, Finland

Abstract

Background The need to improve the care of people with complex care requirements has been driving the reforms integrating care processes. This study examines the effect of the integration of health services on health care usage and the processes and outcomes of care among type 2 diabetes patients. Methods Data include all type 2 diabetes patients who lived in North Karelia, Finland, between 2014 and 2018. Health care contacts and glycated haemoglobin (HbA1c) measurements were obtained from the electronic health records. Logistic, Poisson and linear models with generalised estimating equations and the Friedman test were used to study the differences between years. Results The health care usage was highest in 2017, the first year of a new organisation, and smallest in the following year. Before the new organisation, the health care usage was lowest in 2014, being slightly higher compared with 2018. Between the last two years, the mean number of contacts per person declined from 3.25 to 2.88 (-0.37, p < 0.001). The decreasing pattern seen in total health care usage was most obvious among contacts with primary health care nurses. The number of contacts increased only among specialised care nurses between the last two years. The number of HbA1c measurements was also in its lowest in 2018 but in its highest in 2015. Between the years 2014 and 2018, the difference in the mean number of contacts was − 0.05 (p = 0.011) for those not measured, -0.02 (p = 0.225) for those measured and within the target level of HbA1c, and 0.12 (p = 0.001) for those measured and not at the target level of HbA1c. Conclusions Health care integration first increased the health care usage but then brought it to a slightly lower level than before. The changes were most obvious in primary health care nurses’ appointments, and no decline was observed in secondary-level care. Even though the numbers of HbA1c measurements and the proportion measured declined, measurements increased among those with poor glycaemic control. The observed changes might reflect the better targeting and more concordant services in different service units.

Trajectories of Body Mass Index and Risk for Diabetes Complications and All-Cause Mortality in Finnish Type 2 Diabetes Patients

“…It covers demographic, diagnosis and laboratory data from both public primary and specialized healthcare services. 21 , 22 We collected data on patients’ birth year, sex, measurements of BMI, fasting plasma glucose (FPG), glycated hemoglobin (HbA1c) and low-density lipoprotein (LDL), diagnosis codes and dates for T2D and complications, as well as the date of death.…”

Data-Driven Identification of Long-Term Glycemia Clusters and Their Individualized Predictors in Finnish Patients with Type 2 Diabetes

“…Before that, all the municipalities had introduced identical electronic health register (EHR) called Mediatri in 2010‒2011, and it has been in use since integration both in primary and specialized care, too. 16 EHR data were obtained from the Siun sote to identify a population-based cohort of patients with a diagnosed T2D at the end of 2012 as identified with the 10th revision of International Classification of Diseases (ICD-10) code E11 (N = 10139). EHRs provided us the data on utilization of both primary health care and specialized care for all patients living in the North Karelia region.…”

Data-driven long-term glycaemic control trajectories and their associated health and economic outcomes in Finnish patients with incident type 2 diabetes

“…Municipalities are responsible for organizing and financing public health and social care services for their residents. Siun sote—Joint municipal authority for North Karelia social and health services was established in the region of North Karelia at the beginning of 2017 [ 6 ]. Instead of one municipality, Siun sote joins healthcare organisations of 13 municipalities with around 166 000 inhabitants.…”