The doctoral dissertation in the field of Public Health will be examined at the Faculty of Health Sciences at Kuopio Campus. The public examination will be streamed online.
What is the topic of your doctoral research? Why is it important to study the topic?
This thesis assesses trends in the care of type 2 diabetes (T2D) in North Karelia, Finland using electronic health records. It also evaluates the effect of changes in the healthcare organization and the team-based service model on service use and treatment levels among people with T2D. It concentrates on processes, treatment achievements and medication. The measurement activity and treatment levels of glycated haemoglobin (HbA1c) and low-density lipoprotein (LDL) are used as process and treatment outcome indicators.
Continuous monitoring of care outcomes is essential for identifying evidence-based treatment gaps in the management of type 2 diabetes. It also helps to recognize patient groups who may need more attention or tailored treatment approaches. Using these insights to improve and refine care processes is crucial for enhancing treatment effectiveness.
What are the key findings or observations of your doctoral research?
The measurement activity of HbA1c and LDL cholesterol remained steady in 2012–2017. The proportion of those who achieved the target value of HbA1c decreased 1 %-unit yearly, the same proportion for LDL reduced same amount. Women were measured more and they achieved the HbA1c target more often than men. However, men achieved the LDL target more often than women and the difference between sexes increased in the follow-up.
Less than 10% were without medication in 2013–2019. About one third use metformin as a monotherapy. Short- and long-acting insulin together with gliptine each had less than one fifth of users. The proportion of users of SGLT2-inhibitors increased most in the follow-up, from 1.6 % to 11 %. Glucagon-like peptide-1 receptor agonists (GLP-1 analogues) and other medication groups had fewer than 3.5% of users each year. Short-acting insulin users had the poorest and worsening HbA1c levels. Organisational change increased the number of appointments with nurses in the first year, but in the following year they decreased to a lower level than prior to the changes. Service use decreased less among individuals with poor control of HbA1c. The team-based service model increased T2D-related primary care remote contacts with nurses for a couple of years, but these also later decreased to a lower level. The number of other contacts declined. The team-based service model had no effect on measurement activity or treatment levels of HbA1c or LDL.
As a whole, T2D care in North Karelia is at a good level. The aging population brings challenges to HbA1c control with slightly increasing values. However, improvements can be seen in LDL values especially among men. The transitions between medications largely followed the recommended order according to clinical guidelines for intensifying drug treatment. The integration of healthcare services first increased healthcare use but brought it later to a lower level than it had been before the reform. The changes were most prominent in contacts with primary healthcare (PHC) nurses.
How can the results of your doctoral research be utilised in practice?
This thesis utilises electronic health records (EHRs), which contain information on all public primary and specialised healthcare contacts. North Karelia has had common EHRs since 2011 and it has been actively developed ever since. Such EHRs are essential in evaluating trends and changes in healthcare. When used effectively, data from EHRs has great potential to enhance the understanding of healthcare changes and care quality. However, better utilisation of the data requires development of both regional and national reporting platforms.
What are the key research methods and materials used in your doctoral research?
All adults with T2D were identified from the regional electronic health records. The data was analysed in annual cohorts excluding those who were diagnosed or had died in that year. The number of patients increased steadily from 11229 to 12969 in 2012–2018. The data used in the analyses of medication include those who had HbA1c measurements and were 85 years old or less (range of annual number of patients 7391–9015 in 2013–2019). The effect of the initiation of the team-based service model was evaluated in a cohort of patients who were diagnosed by 2016 and were alive in 2023 (N=6312). Generalised mixed models and generalised models with generalised estimating equations were used to assess the differences between years and other explanatory factors. These studies were funded by the Strategic Research Council of the Academy of Finland (project IMPRO), the Finnish Diabetes Association and the Next Generation EU, through the Ministry of Social Affairs and Health of Finland.
The doctoral dissertation of Marja-Leena Lamidi, MSc, entitled Using electronic health records to track trends in care, medication, and healthcare utilization among people with type 2 diabetes will be examined at the Faculty of Health Sciences. The Opponent in the public examination will be Professor Ilmo Keskimäki of the Finnish Institute for Health and Welfare (THL), and the Custos will be Professor Tiina Laatikainen of the University of Eastern Finland. The public examination will be held in Finnish.
Doctoral defence (in Finnish)
For further information, please contact:
Marja-Leena Lamidi, MSc, [email protected]
