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38 Primary care quality – national quality indicators to reduce overdiagnosis and overtreatment in primary health care
  1. Susanne Steen1,
  2. Eva Arvidsson2,3,
  3. Charlotta Malmer Hagstam4,
  4. Jörgen Månsson5,
  5. Malin André6
  1. 1SALAR, Stockholm, Sweden
  2. 2Futurum, Jönköping, Sweden
  3. 3Linköping University, Linköping, Sweden
  4. 4Region Skåne, Malmö, Sweden
  5. 5University of Gothenburg, Gothenburg, Sweden
  6. 6Region Uppsala, Uppsala, Sweden


Objectives Primary Care Quality (PCQ) is a tool that helps to decrease overdiagnosis and overmedication in primary health care. Examples on how PCQ has been used for quality improvement by primary health care professionals in Sweden will be presented.

Method PCQ is a national system of quality indicators constructed by primary health care professionals which aim to deliver data for quality improvement by visualising automatically retrieved data from EMRs. The indicators are based on national guidelines for patients with chronic diseases and infections but also qualities like continuity, priority setting and care for multimorbidity.

One challenge has been to balance disease specific recommendations on early diagnose and treatment from national authorities and secondary care with the risk of overmedication and overtreatment. Antibiotics and addictive substances are also at risk for being overprescribed. The indicators on infections in PCQ are developed together with the Public Health Agency and the Swedish strategic programme against antibiotic resistance. The novelty of PCQ is the ability to link prescribing data to certain diagnoses and laboratory tests.

Two projects will be presented where PCQ have been used for quality improvement by reducing drug prescribing.

Results Almost all Swedish primary health care centres (PHCC) now have access to PCQ and the use of PCQ for improvement is increasing.

PCQ consists of around 200 quality indicators and approximately 30 of them concern preventing drug overtreatment (antibiotics, benzodiazepines, opioids, proton-pump inhibitors, and medication among elderly). Indicators on laboratory tests in common infections and indicators concerning prevalence/incidence of different diagnoses at different PHCCs can be used to prevent overdiagnosis. [SS1].

PCQ show improvement in several aspects. Two examples of use of PCQ is the decrease of prescribing of benzodiazepines in a PHCC in Region Jönköping and the reduction of prescribing antibiotics in a PHCC in Region Skåne.

Conclusions Medical guidelines often concern ‘what should be done’, but quite a few indicators in PCQ concern overtreatment and overdiagnosis. Indicators for multimorbidity are constructed to balance disease specific indicators. The system is in use at more than 90% of Swedish PHCCs and results of the improvement efforts are visible in the figures at the PHCCs.

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