Pia M. Jonsson

GENDER EQUITY IN HEALTH CARE: THE CASE OF SWEDISH DIABETES CARE

To explore the issue of gender equity in diabetes care in Sweden and to develop strategies for monitoring gender equity in health care, population-based studies and statistics published since 1990 were reviewed that contained gender-specific data on health care utilization, glycemic control, patient satisfaction, health-related quality of life, and mortality from diabetes. The review shows that diabetic women in Sweden report more frequent outpatient contacts, less patient satisfaction, and a lower health-related quality of life than diabetic men. No gender differences were found in the level of glycemic control. Young and middle-aged men with diabetes have a high excess all-cause mortality as compared with nondiabetic men. A trend toward stronger social gradient in mortality among women than men with diabetes was observed in a large nationwide study.To explore the issue of gender equity in diabetes care in Sweden and to develop strategies for monitoring gender equity in health care, population-based studies and statistics published since 1990 were reviewed that contained gender-specific data on health care utilization, glycemic control, patient satisfaction, health-related quality of life, and mortality from diabetes. The review shows that diabetic women in Sweden report more frequent outpatient contacts, less patient satisfaction, and a lower health-related quality of life than diabetic men. No gender differences were found in the level of glycemic control. Young and middle-aged men with diabetes have a high excess all-cause mortality as compared with nondiabetic men. A trend toward stronger social gradient in mortality among women than men with diabetes was observed in a large nationwide study. The reasons for the observed gender differences are uncertain but may constitute a combination of medical, psychological, and social factors. Monitoring the impact of gender should become an integrated part of quality management in diabetes care. As long as the relationship between use and outcomes of care is not fully understood, analyses of gender equity should address both health care utilization and outcomes of care.

Diffusion of magnetic resonance imaging in Iran

OBJECTIVES The aim of this article is to describe the diffusion of magnetic resonance imaging (MRI) in Iran, including regional variations during the period of 1990 to 2005 and international comparisons. METHODS Data on the diffusion of MRI were obtained from the Medical Equipment Office of the Ministry of Health (MOH) and, using self-administered questionnaires, from forty-one universities specializing in medical sciences. Data were gathered from the year of first purchase up to mid-2005. Information for international comparisons was obtained from the Organization for Economic Cooperation and Development health data of 2006. RESULTS Iran purchased its first MRI unit in 1990. Since then, the number of MRI units has increased remarkably. The diffusion curve of MRI in Iran follows an S-shaped curve with a very slow speed in the period of 1991-95. Accelerated adoption occurred later coinciding with a significant influence from the private sector, especially from 1999. Iran had ninety-three MRI units in 2005, and the number of MRI units per million in the population was 1.36. CONCLUSIONS The number of MRI units in provinces is not in direct proportion to the number of their inhabitants. Rational adoption and equitable diffusion of MRI may require the MOH and regulatory bodies to improve their ability in health technology assessment and integrate it into the policy making regarding adoption, diffusion, and utilization of health technologies.

Excess costs of medical care 1 and 8 years after diagnosis of diabetes: estimates from young and middle-aged incidence cohorts in Sweden.

To analyze the excess costs of medical care during the first decade after diabetes diagnosis, we surveyed two national incidence cohorts who contracted diabetes at age of 15-34 years and matched control groups from the general population of Sweden. Ninety percent of the diabetic subjects were on insulin treatment. Data on healthcare utilization and use of glucose lowering drugs and medical devices were collected via a questionnaire mailed to a recent cohort 1 year after diagnosis and a previously registered cohort 8 years after diagnosis. Costing was based on average national costs of hospital inpatient and out-patient care, an original study of daycare costs, and sales prices of the National Corporation of Swedish Pharmacies. One year after diabetes diagnosis, the annual excess costs of care were US

Diabetes mellitus and health service utilization: a case-control study of outpatient visits 8 years after diagnosis.

4743 among men and US

Diffusion of interferon beta in Iran and its utilization in Tehran

4976 among women (1997 prices). Hospital inpatient care accounted for more than 50% of the excess costs. Eight years after diagnosis, the excess costs were US

Changing healthcare utilization patterns in diabetes mellitus: case-control studies 1 year and 8 years after diagnosis

2010 among men and US

Changing healthcare utilization patterns in diabetes mellitus : case-control studies 1 year and 8 years after diagnosis

2734 among women. The higher costs for women were mainly related to hospital out-patient care, but also to more intensive self-monitoring. We conclude that diabetes in young and middle-aged people is a major economic challenge even before significant complications may have developed.

Diabetes duration and health-related quality of life in individuals with onset of diabetes in the age group 15—34 years – a Swedish population-based study using EQ-5D

All incident cases of diabetes mellitus in the age group 15 to 34 years have been prospectively registered in Sweden since January 1983. To analyse the utilization of outpatient services 8 years after disease onset, we selected the cases registered in 1983 and two controls per case from the general population, matched by age, gender, and county of residence. In 1991, retrospective data about utilization patterns during a 3‐month period were collected via a mailed questionnaire, returned by 317 (72 %) patients with diabetes and 586 (68 %) controls. Seventy‐four percent of the cases and 19 % of the controls reported at least one visit to a hospital outpatient clinic, including accident and emergency departments. The odds ratio for one visit was 14 (95 % CI 9.6–20), for two visits 11 (95 % CI 7.0–18), and for three or more visits 8.9 (95 % CI 5.6–14). Even when specialized diabetes clinics were excluded from the analysis, the cases had higher odds for visits to internal medicine clinics, to ophthalmology clinics, and to gynaecology clinics, but not for visits to surgical clinics or to accident and emergency departments. Of non‐hospital outpatient services, only visits to nurse practitioners were reported by a higher percentage of diabetic responders. Twenty‐seven percent of patients with diabetes, as compared to 9 % of the controls, had visited both hospital and non‐hospital outpatient offices. Females were overrepresented among diabetic high‐consumers. The results indicate that most young to middle‐aged Swedish persons with diabetes are monitored at hospital outpatient offices, but considerable overlap exists between hospital and non‐hospital outpatient services. Further research is needed into the determinants of utilization patterns in diabetes, such as gender.

Patient claims and complaints data for improving patient safety

There are few studies on the diffusion of expensive new therapies in low‐ or middle‐income countries. The objectives of this study were to describe the diffusion of interferon beta for the treatment of patients with multiple sclerosis (MS) in Iran and to analyze its use in a cohort of 890 patients in Tehran registered in the Iranian MS Society (IMSS) registry.

Gender equity in health care in Sweden--minor improvements since the 1990s.

Diabet. Med. 29, 784–791 (2012)