title: The Swedish National Diabetes Register in clinical practice and evaluation in primary health care.
abstract: Aim The purpose of this project is to describe the use of the Swedish National Diabetes Register (NDR) in clinical practice in a Swedish county and to specifically monitor the diabetes care routines at two separate primary health-care centres (PHCC) with a special focus on older patients.
  
  
  
  According to Swedish law, all health-care units have to maintain a system for quality evaluation and improvement. As the NDR holds the most important quality indicators, implementation of the NDR in primary care was carried out by an implementation project in 2002-2005.
  
  
  
  Initially, a digital questionnaire about NDR routines was sent to all PHCC. Statistics about hemoglobin adult 1c (HbA1c) and blood pressure (BP) was presented for the diabetes teams at two centres who were also interviewed. The responses became the basis for a focus group interview with both teams together, with data subject to content analysis. Findings The study showed that reporting to the NDR has become a compulsory routine in primary care. The diabetes nurse specialist was responsible for the practical management of the register and used the NDR for continuous monitoring of the patients. Most centres used the NDR's statistics for evaluation and analyses annually. The diabetes nurse adapted the visits to the patient's wishes and general condition. Only in terms of target values for HbA1c and BP did they accept slightly higher values for the older patients. Since the NDR was implemented, the registration rate has remained at 75% and has not increased. The reason given was that patients with diabetes living in nursing homes are checked up by the municipal nurse who does not use the NDR. However, the risk of omitting older patients in the NDR could be considerably decreased if data could be transferred from the electronic patient record.
authors.affiliation: 1Social Scientist,R&D Department of Local Care, Region Östergötland and Faculty of Medicine and Health Science,Linköping University,Linköping,Sweden.
authors.forename: Ing-Marie
authors.initials: IM
authors.lastname: Hallgren Elfgren
authors.affiliation: 2Registered BLS, Associate Professor, Manager,Forensic Toxicology Laboratory,National Board of Forensic Medicine, Faculty of Medicine and Health Science,Linköping University,Linköping,Sweden.
authors.forename: Ewa
authors.initials: E
authors.lastname: Grodzinsky
authors.affiliation: 3R&D Supervisor,R&D Department of Local Care,Region Östergötlandand Faculty of Medicine and Health Science,Linköping University,Linköping,Sweden.
authors.forename: Eva
authors.initials: E
authors.lastname: Törnvall
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003920:Diabetes Mellitus / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000379:methods; D011320:Primary Health Care / Q000592:standards*; D058996:Quality Improvement; D012042:Registries; D013548:Sweden
keywords: diabetes care; older patients; primary health care; quality register