Sessio 6 / 2021
SESSION 6: Effectiveness of care and health services
Chair: Emma Aarnio (UEF)
Impact of the COVID-19 Pandemic on health service usage among patients with type 2 diabetes in North Karelia, Finland
Laura Inglin1, Katja Wikström1,2, Marja-Leena Lamidi1, Tiina Laatikainen1,2,3
1 Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
2 National Institute for Health and Welfare, Helsinki, Finland
3 Joint municipal authority for North Karelia health and social services (Siun sote), Joensuu, Finland
Aims
The COVID-19 pandemic has challenged health systems and their capacity to deliver essential health services while responding to COVID-19. This study examines the pandemic’s impact on health service usage among patients with type 2 diabetes in the region of North Karelia, Finland.
Methods
This retrospective cohort study used electronic health records of 11458 type 2 diabetes patients, comprising all primary and specialised care contacts in 2019 and 2020. We analysed diabetes and oral health care contacts with nurses, doctors and dentists in primary care and all emergency visits in specialised care. We compared healthcare usage in three different periods in 2020 (pre-lockdown [1 January–15 March 2020], lockdown [16 March–31 May 2020], post-lockdown [1 June–31 December 2020]) with the equivalent period in 2019.
Results
During the lockdown period, the number of diabetes-related contacts decreased significantly but quickly increased again to nearly the same level as 2019. Overall, healthcare usage was lower in the pandemic year, with proportionally 9% fewer contacts per person (mean 2.08 vs 2.29) and a proportionally 9% lower proportion of patients with any contact (59.9% vs 65.8%). The proportion of remote consultations was similar in both years in the pre-lockdown period (56.3–59.5%) but then increased to 88.0% during the 2020 lockdown period. Patterns were similar when analysed by age group and gender. Emergency visits went down significantly at the beginning of the lockdown period but a “rebound effect” was observed, so by the end of the year, the number of emergency visits in 2020 exceeded the numbers of the previous year.
Conclusion
Despite the COVID-19 pandemic, diabetes care was continuous, and even elderly patients over 70 years of age accessed health services. Delivery of essential services was facilitated by processes that strongly relied already before the pandemic on telemedicine for many services.
Internet-based lifestyle intervention to prevent type 2 diabetes through healthy habits: secondary analysis of long-term user engagement trajectories of randomized controlled trial
Piia Lavikainen1, Elina Mattila2, Pilvikki Absetz3, Marja Harjumaa2, Jaana Lindström4, Elina Järvelä-Reijonen3, Kirsikka Aittola3, Timo Lakka5, Mark van Gils2, Jussi Pihlajamäki3,6, Janne Martikainen1
1 School of Pharmacy, University of Eastern Finland, Kuopio, Finland
2 VTT Technical Research Centre of Finland Ltd, Espoo, Finland
3 Institute of Public Health and Clinical Nutrition, School of Medicine, University of Eastern Finland, Kuopio, Finland
4 Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
5 Institute of Biomedicine, University of Eastern Finland, Kuopio, Finland
6 Endocrinology and Clinical Nutrition, Department of Medicine, Kuopio University Hospital, Kuopio, Finland
Introduction
Digital health interventions may offer a scalable way to prevent type 2 diabetes (T2D) by providing early support for healthy behaviours. However, ensuring continued engagement with digital solutions is a challenge impacting on the expected effectiveness. We aimed to identify trajectories of user engagement with the BitHabit app supporting healthy lifestyle in persons at risk of T2D, to examine predictors of trajectories, and to investigate association between the identified trajectories and 12-month changes in T2D risk factors.
Methods
We used data from 1926 participants of the intervention arms of the one-year StopDia randomized controlled trial conducted in Finland in 2017‒2019. Latent class growth models were applied to identify user engagement trajectories with the app during 11-months. Predictors for trajectory membership were examined with multinomial logistic regression models. Analysis of covariance was utilized to investigate association between trajectories and 12-month changes in T2D risk factors.
Results
Four user engagement trajectories were identified: terminated usage (46.9%), weekly usage (38.0%), twice weekly usage (10.8%), and daily usage (4.3%). Active app use during the first month, higher net promoter score after the first 1‒2 months of use, older age, and better diet quality at baseline increased the odds of not belonging to the terminated usage trajectory. Compared with other trajectories, daily usage showed higher increase in diet quality and more pronounced decrease in BMI and waist circumference at 12 months compared with other trajectories.
Conclusions
More than half of the participants continued to use the app throughout the 12-month intervention. Initial user engagement and experience during the first month of the intervention, and diet quality predicted long-term user engagement. Daily use throughout the study showed the most beneficial changes in risk-factors. These findings could be used in further developments aiming to predict response and adapt interventions for persons at risk of disengagement.
New hypertension and quality of life
Aapo Tahkola1, Päivi Korhonen2, Hannu Kautiainen3, Teemu Niiranen2, Pekka Mäntyselkä1,4
1 University of Eastern Finland, Kuopio, Finland
2 University of Turku, Turku, Finland
3 Medcare Oy, Äänekoski, Finland
4 Primary Health Care Unit, Kuopio University Hospital
Background
Effective prevention and treatment of hypertension is one of the most potential interventions in terms of preventing cardiovascular deaths and disabilities. However, the treatment control is often poor. This may be partly explained by the impact of hypertension diagnoses and treatment on health-related quality of life. Quality of life is also an important outcome for a hypertensive patient. Most of the previous studies on health-related quality of life in hypertension have concentrated on patients with treated hypertension and less is known about the initiation of medication and the first treatment year.
Methods
In this interventional study, we followed 111 primary care patients with newly diagnosed hypertension in real world primary care setting in Finland for 12 months.
Results
We found significant decrease in both systolic and diastolic blood pressure levels, as well as modest decrease in cholesterol levels and alcohol consumption. However, the health-related quality of life also slightly deteriorated during the first treatment year.
Conclusions
Our study shows that the initiation of hypertension treatment results in cardiovascular risk decrease among newly diagnosed Finnish hypertensive patients, but it is accompanied by small negative impact on health-related quality of life. However, the deterioration in health-related quality of life is of small magnitude and earlier research demonstrates several measures to enhance treatment and avoid impairment in health-related quality of life.
Trial registration: ClinicalTrials NCT02377960 (Date of registration: 04/03/2015)
How are the benefits of a regional chronic care quality monitoring system generated? – Clinical professionals’ perspective
Iiris Hörhammer1, Katariina Silander2, Hilkka Tirkkonen3, Päivi Rautiainen3, Tiina Laatikainen4,5, Miika Linna1,4
1 Aalto University, Department of Industrial Engineering and Management, Espoo, Finland
2 Hospital District of Helsinki and Uusimaa (HUS), Helsinki, Finland
3 Joint Municipal Authority for North Karelia Social and Health Services (Siun Sote), Joensuu, Finland
4 University of Eastern Finland, Joensuu, Finland
5 Finnish Institute for Health and Welfare, Helsinki, Finland
Background
Chronic care quality monitoring systems that employ electronic health record data have shown great promise in value-based healthcare. While the impacts of these systems on cost-effectiveness of care are contingent upon changes in clinical processes, little is known of clinical professionals’ perspective to these changes.
Objective
This study aims to portrait how the impact of a regional chronic care quality monitoring system on cost-effectiveness of care is realized in the clinical professionals’ work.
Data and methods
Semi-structured interviews (N=11) in a purposive sample of nurses and physicians who treat diabetic patients and supervisors of nurses and physicians in the pre-implementation phase of a regional quality monitoring system. The interview data is thematically analyzed.
Findings
Clinical professionals identify potential of the system to improve regional quality and cost-effectiveness of care via improved compliance to and continuous development of evidence-based care guidelines, and more efficient allocation of professional resources to those patients in need. More specifically, the system is perceived to support 1) establishing of shared standard targets and practices in multi-professional teams, 2) appropriate targeting of training for units and professionals , 3) transferring greater share of diabetes care follow-up to nurses while allocating physician resource to clinical decision making, and 4) establishing explicit lines of accountability for units and professionals. Risks of the implementation were perceived in 1) blind adherence to patient-group specific outcome targets, 2) poor collective use and training of the system, 3) poor usability and linkage to clinical decision making, 4) disrespectful comparison between units and professionals, and 5) unfair comparison disregarding unit differences in professional resources and patient population characteristics.
Conclusions
Clinical professionals’ perceptions of the benefits and risks of chronic care quality monitoring can guide successful implementation. Favorable impact of monitoring on cost-effectiveness of care calls for a culture of respect and continuous improvement, and redivision of work tasks between professional groups.