This study shows that patients' awareness of the significance of their active role in addressing polypharmacy needs to be increased. This includes understanding that trusting the doctor does not preclude asking questions or seeking more information. Thus, interventions which improve patients' communication skills and address specific issues of polypharmacy, particularly in elderly patients, should be designed. GPs might support patients by 'inviting' their contribution.

This pilot study shows that DECADE can support patient activation. The effects can be expected to be stronger in a larger study and in comparison to usual care. If this can be confirmed, DECADE should be embedded in routine patient care.

BackgroundPrimary healthcare in Sweden has undergone comprehensive reforms, including freedom of choice regarding provider, freedom of establishment and increased privatisation aiming to meet demands for quality and availability. In this system privately and publicly owned primary care centres with different business models (for-profit vs non-profit) coexist and compete for patients, which makes it important to study whether or not the type of ownership influences the quality of the primary healthcare services.MethodsIn this retrospective observational study (April 2011 to January 2014) the patient perceived quality, the use of antibiotics and benzodiazepine derivatives, and the follow-up routines of certain chronic diseases were analysed for all primary care centres in Region Västra Götaland. The outcome measures were compared on a group level between privately owned (n = 86) and publicly owned (n = 114) primary care centres (PCC).ResultsIn comparison with the group of publicly owned PCCs, the group of privately owned PCCs were characterized by: a smaller, but continuously growing share of the population served (from 32 to 36 %); smaller PCC population sizes (avg. 5932 vs. 9432 individuals); a higher fraction of PCCs located in urban areas (57 % vs 35 %); a higher fraction of listed citizens in working age (62 % vs. 56 %) and belonging to the second most affluent socioeconomic quintile (26 % vs. 14 %); higher perceived patient quality (82.4 vs. 79.6 points); higher use of antibiotics (6.0 vs. 5.1 prescriptions per 100 individuals in a quarter); lower use of benzodiazepines (DDD per 100 patients/month) for 20–74 year olds (278 vs. 306) and >74 year olds (1744 vs.1791); lower rates for follow-ups of chronic diseases (71.2 % vs 74.6 %). While antibiotic use decreased, the use of benzodiazepines increased for both groups over time.ConclusionsThe findings of this study cannot unambiguously answer the question of whether or not the quality is influenced by the healthcare centre’s type of ownership. It can be questioned whether the reform created conditions that encouraged quality improvements. Tendencies of an (unintended) unequal distribution of the population between the two groups with disparities in age, socio-economy and geography might lead to unpredictable effects. Further studies are necessary for evidence-informed policy-making.

The primary health-care centre (PHCC) participating in the study has had financial problems for several years and it has been particularly difficult to recruit general practitioners (GPs). As a result, the access rate to the PHCC was low. The purpose of this study was to increase the access rate to the PHCC and to make the most efficient use of the staff by introducing a structured patient sorting system. All personnel were involved in the implementation process and participated regularly in interdisciplinary work-groups. A variety of Drop-in receptions were created and a manual for sorting patients by condition was introduced. The main finding was that the total access rate to the PHCC increased by 27% and that each staff member increased their personal access rate by an average of 13%. Eighty-three percent of the patients who were initially treated by the rehabilitation team were treated solely by the team and did not need to see a GP. No medical backlashes were reported. These findings indicate a more efficient use of the personnel. Furthermore, both personnel and patients indicated an improvement in the possibility to book patient appointments after the introduction of the structured patient sorting system.