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Digitization, patient choice and quality in primary care

Two of the major changes that have taken place in the healthcare market in Sweden in recent years are the introduction of patient choice in primary care and the introduction of digital healthcare services. In this project, we will address issues related to these two areas.

Aim of the project

The overall aim of the project is to contribute to knowledge in the area of digitization, patient choice and quality in primary care in order to help decision-makers improve the healthcare system. In the project, we investigate quality measures in primary care and analyze whether patients take quality of care into account in their choice of provider. We also analyze the effects of digital healthcare visits and the determinants of digital healthcare utilization.

Results in brief

In the first part of the project, we investigated a potential quality measure in primary care related to recording of diagnoses. The measure indicates the percentage of those who have received one of four different diagnoses in inpatient care who are later registered with the same diagnosis in primary care, within a two-year period. We used registry data from the Stockholm healthcare database VAL and were able to show that having a recorded diagnosis in primary care was associated with being prescribed a recommended drugs. This means that the measure has potential as a quality indicator for primary care.

In the second sub-study, we aimed to investigate if patients are willing to make a trade-off between distance to chosen provider and quality of care. A second objective was to explore more generally the determinants for patient choice of primary health care provider and investigate differences between patient groups. The study is not yet published but the preliminary results indicate that quality influences choice of provider. However, the effects are marginal, and distance remains the dominating factor in choice of primary healthcare centre. Apart from distance, the provider characteristic that influenced choice the most was a low Care Need Index of the listed population.

Continued work

In future work, we will focus on digital healthcare visits. We will investigate who utilizes digital healthcare and the effects of digital healthcare consumption on the overall healthcare system.

The project will continue until autumn 2021.

Reports and publications

Recording a diagnosis of stroke, transient ischaemic attack or myocardial infarction in primary healthcare and the association with dispensation of secondary preventive medication: a registry-based prospective cohort study.
Dahlgren C, Geary L, Hasselström J, Rehnberg C, Schenck-Gustafsson K, Wändell P, et al
BMJ Open 2017 Sep;7(9):e015723

Contact person

Cecilia Dahlgren

PhD Student
Unit for Health Economics and Policy
C7 Department of Learning, Informatics, Management and Ethics