Article Text

Download PDFPDF
86 Quality indicators aiming to help primary care in sweden to balance between what to do and what not to doquality indicators aiming to help primary care in sweden to balance between what to do and what not to do
  1. Malin André1,
  2. Ulrika Elmroth2,
  3. Eva Arvidsson3,
  4. Jörgen Månsson4
  1. 1Dep of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
  2. 2Swedish Association of Local Authorities and Regions, Stockholm, Sweden
  3. 3Academy for Health and Care, Jönköping County, Sweden
  4. 4Department of Public Health and Community Medicine, The Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden


Objective To construct evidence based indicators, automatically retrieved from electronic medical records (EMR), for quality improvement including indicators to prevent overtreatment and overdiagnosis.

Method ‘Primary Care Quality’ is a national system consisting of nationally specified quality indicators. The data for the indicators is automatically retrieved from EMRs. The indicators are presented at the HC centres for benchmarking but also to identify individual patients.

The indicators reflect quality of care for patients with chronic diseases, infections as well as qualities like priority setting and multimorbidity. The project was initiated by the professional organisations in Primary Care and most of the indicators are built on evidence based national guidelines. In line with similar systems in many countries most indicators assess certain measures being taken, but in addition this system includes several indicators aiming to point out possible overdiagnosis and overtreatment.

Result The indicators aiming to prevent overtreatment concern use of antibiotics, bensodiazepines, hypnotics, proton pump inhibitors and medication among the elderly.

A few indicators concern overdiagnosis (laboratory test in common infections). However, comparing prevalence of different diagnoses at different HCs may a way to inspire discussion on possible overdiagnosis, especially prevalence of different infectious diseases as well as depression and anxiety. Moreover there are indicators for multimorbidity, which aim to balance disease specific indicators since guidelines usually have to be adjusted to the individual patient in patients with more than one chronic disease.

Conclusion Although most indicators concern what should be done, quite a few concern overtreatment and overdiagnosis. Indicators for multimorbidity are constructed to balance disease specific indicators.

It is possible to construct indicators from automatically retrieved data from the EMR for use in discussions on overtreatment and overdiagnosis in primary care.

How effective the indicators are for reducing overtreatment and overdiagnosis is not known yet.

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.