title: Comparing and improving chronic illness primary care in Sweden and the USA.
abstract: Purpose - The purpose of this paper is to identify opportunities for improving primary care services for people with chronic illnesses by comparing how Sweden and US services use evidence-based practices (EBPs), including digital health technologies (DHTs). Design/methodology/approach - A national primary healthcare center (PHCC) heads surveys in 2012-2013 carried out in both countries in 2006. Findings - There are large variations between the two countries. The largest, regarding effective DHT use in primary care centers, were that few Swedish primary healthcare compared to US heads reported having reminders or prompts at the point of care (38 percent Sweden vs 84 percent USA), despite Sweden's established electronic medical records (EMR). Swedish heads also reported 30 percent fewer centers receiving laboratory results (67 percent Sweden vs 97 percent USA). Regarding following other EBPs, 70 percent of Swedish center heads reported their physicians had easy access to diabetic patient lists compared to 14 percent in the USA. Most Swedish PHCC heads (96 percent) said they offered same day appointment compared to 36 percent in equivalent US practices. Practical implications - There are opportunities for improvement based on significant differences in effective practices between the countries, which demonstrates to primary care leaders that their peers elsewhere potentially provide better care for people with chronic illnesses. Some improvements are under primary care center control and can be made quickly. There is evidence that people with chronic illnesses in these two countries are suffering unnecessarily owing to primary care staff failing to provide proven EBP, which would better meet patient needs. Public finance has been invested in DHT, which are not being used to their full potential. Originality/value - The study shows the gaps between current and potential proven effective EBPs for services to patients with chronic conditions. Findings suggest possible explanations for differences and practical improvements by comparing the two countries. Many enhancements are low cost and the proportionate reduction in suffering and costs they bring is high.
authors.affiliation: LIME/MMC , Karolinska Institutet, Stockholm, Sweden.
authors.forename: John
authors.initials: J
authors.lastname: Øvretveit
authors.affiliation: Center for Healthcare Organizational and Innovation Research (CHOIR), School of Public Health, University of California Berkeley, Berkeley, California, USA.
authors.forename: Patricia
authors.initials: P
authors.lastname: Ramsay
authors.affiliation: Center for Healthcare Organizational and Innovation Research (CHOIR), School of Public Health, University of California Berkeley, Berkeley, California, USA.
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Shortell
authors.affiliation: LIME/MMC, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Mats
authors.initials: M
authors.lastname: Brommels
mesh_terms: D019090:Case Management / Q000458:organization & administration; D002908:Chronic Disease / Q000628:therapy*; D057286:Electronic Health Records / Q000458:organization & administration; D019317:Evidence-Based Medicine; D006801:Humans; D010348:Patient Care Team / Q000458:organization & administration; D019095:Point-of-Care Systems / Q000458:organization & administration; D017410:Practice Guidelines as Topic; D011320:Primary Health Care / Q000458:organization & administration* / Q000592:standards; D017010:Reminder Systems; D013548:Sweden; D014481:United States
keywords: Chronic illness; Evidence-based healthcare; Health information technology; Primary healthcare; Quality; Service delivery organization