Implementation of a Care Manager Organization and Its Association with Health Care Contacts and Psychotherapy: A Register-Based Study of Real-Life Outcomes at Primary Health Care Centers in Sweden

Figures & data

Table 1 Descriptive Statistics of PHCCs by Care Manager Status (CAU⁺, CMO⁺⁺) at Year 1 (September 2015 – August 2016) and Year 2 (September 2016 – August 2017)

	Introductory Phase (Year 1)			Establishment Phase (Year 2)
	CAU	CMO		CAU	CMO
	n (%)	n (%)	P	n (%)	n (%)	P
PHCC status
Public	60 (45)	53 (65)	0.003**	60 (45)	53 (65)	0.003**
Private	74 (55)	28 (35)		74 (55)	28 (35)
Geographical location^a
Urban	117 (87)	69 (85)	0.66	116 (87)	69 (85)	0.78
Rural	17 (13)	12 (15)		18 (13)	12 (15)
PHCCs with no. of listed patients			0.004**			0.01*
<5000	35 (29)	11 (14)		33 (28)	11 (14)
5000 - <7000	20 (17)	9 (11)		21 (18)	11 (14)
7000 - <10.000	34 (29)	32 (40)		35 (29)	30 (37)
≥10.000	30 (25)	29 (36)		31 (26)	29 (36)
Median (min-max)	7441 (252–20,219)	9020 (2390–1894)		7811 (503–19,210)	8932 (2667–18,504)
Proportion of patients with CMD diagnosis per PHCC^b,	% (SD)	% (SD)		% (SD)	% (SD)
Women	11.9 (4.3)	11.9 (2.4)	0.40	12.7 (4.7)	12.5 (2.5)	0.41
Men	5.7 (2.2)	5.7 (1.2)	0.25	6.0 (2.7)	6.0 (1.4)	0.33
Total	8.8 (3.2)	8.8 (1.8)	0.33	9.3 (3.5)	9.3 (2.0)	0.38
Mean no. of visits by patients with CMD to^c:	Mean (SD)	Mean (SD)		Mean (SD)	Mean (SD)
Psychotherapist
Women	0.79 (0.60)	0.66 (0.46)	0.32	0.62 (0.43)	0.63 (0.45)	0.89
Men	0.69 (0.49)	0.62 (0.40)	0.65	0.56 (0.39)	0.56 (0.40)	0.92
Total	0.75 (0.54)	0.64 (0.43)	0.31	0.59 (0.40)	0.60 (0.43)	0.91
Nurse
Women	0.93 (0.60)	1.34 (0.49)	0.000***	1.01 (0.65)	1.39 (0.49)	0.001***
Men	1.0 (0.65)	1.40 (0.65)	0.03*	1.06 (0.69)	1.46 (0.58)	0.002***
Total	0.95 (0.59)	1.36 (0.52)	0.001***	1.03 (0.64)	1.42 (0.50)	0.001***
GP
Women	3.0 (0.66)	3.0 (0.44)	0.84	2.93 (0.58)	2.97 (0.45)	0.70
Men	2.70 (0.60)	2.69 (0.42)	0.54	2.68 (0.57)	2.68 (0.41)	0.92
Total	2.87 (0.62)	2.90 (0.42)	0.94	2.85 (0.57)	2.88 (0.42)	0.76

Notes: ^aMeasured by whether the PHCCs had received earmarked reimbursement for their geographical location (ie distant location from large city or hospital, location on an island without bridge connection, et cetera.) during the study period. ^bProportion calculated by dividing number of patients with CMD with number of listed patients at each PHCC group. ^cMean number calculated by dividing number of visits for eg GP by patients with CMD with number of patients with CMD at each PHCC group. *P-value of <0.05. **P-value of <0.01. ***P-value of <0.001.

Abbreviations: ⁺CAU, care as usual; ⁺⁺CMO, care manager organization.

Table 2 Cross-Sectional and Longitudinal Comparisons of Mean Proportion of Health Care Contacts by Care Manager Status (CAU⁺, CMO⁺⁺) at Year 1 (September 2015 – August 2016) and at Year 2 (September 2016 – August 2017), and from Year 1 to Year 2

PHCCs with Proportion of Visits by Patients with CMD to:	CAU Mean %	CMO Mean %	CI^^ Between Groups
Psychotherapist
Women
Year 1	13.5	11.9	−4.3; 1.1
Year 2	11.4	11.6	−2.1; 2.4
CI^^ within groups (DF^§)	−3.4; −0.8**	−1.8; 1.2	(180)
Men
Year 1	12.9	12.1	−3.3; 1.8
Year 2	11.2	11.1	−2.2; 2.0
CI^^ within groups (DF^§)	−3.1; −0.2*	−2.7; 0.6	(178)
Nurse
Women
Year 1	20.6	23.5	0.8; 5.1**
Year 2	22.0	24.7	0.5; 5.0*
CI^^ within groups (DF^§)	0.4; 2.4**	0.03; 2.4*	(180)
Men
Year 1	23.5	25.7	−0.1; 4.6
Year 2	24.0	27.7	1.1; 6.2**
CI^^ within groups (DF^§)	−0.8; 1.9	0.5; 3.6**	(178)
GP
Women
Year 1	56.4	54.9	−4.1; 1.0
Year 2	56.6	54.0	−5.3; −0.1*
CI^^ within groups (DF^§)	−1.0; 1.4	−2.3; 0.5	(180)
Men
Year 1	55.2	53.3	−4.6; 0.8
Year 2	55.3	51.9	−6.0; −0.7**
CI^^ within groups (DF^§)	−1.2; 1.4	−2.9; 0.2	(178)

Notes: *P-value of <0.05. **P-value of <0.01.

Abbreviations: ⁺CAU, care as usual; ⁺⁺CMO, care manager organization; ^{^}CI, confidence intervals; ^§DF, degrees of freedom (n-1).

Table 3 Cross-Sectional and Longitudinal Comparisons of Mean Proportion of Length of Psychotherapy by Care Manager Status (CAU⁺, CMO⁺⁺) at Year 1 (September 2015 – August 2016) and at Year 2 (September 2016 – August 2017), and from Year 1 to Year 2

PHCCs with Proportion of Patients with CMD Receiving:	CAU Mean %	CMO Mean %	CI^^ Between Groups
Short-term psychotherapy (1–5 sessions)
Women
Year 1	75.3	75.7	−3.6; 4.4
Year 2	80.2	75.3	−8.7; −1.1**
CI^^ within groups (DF^§)	2.5; 7.3***	−3.2; 2.4	(203)
Men
Year 1	78.7	79.8	−3.1; 5.2
Year 2	82.4	77.8	−8.7; −0.5*
CI^^ within groups (DF^§)	0.7; 6.6*	−5.4; 1.5	(203)
Long-term psychotherapy (6 sessions)
Women
Year 1	28.4	25.4	−7.3; 1.4
Year 2	22.6	25.0	−1.3; 5.9
CI^^ within groups (DF^§)	−8.7; −2.8***	−3.9; 2.9	(191)
Men
Year 1	24.0	22.6	−5.4; 2.6
Year 2	22.4	22.7	−4.0; 4.7
CI^^ within groups (DF^§)	−4.6; 1.4	−3.3; 3.6	(189)

Notes: *P-value of <0.05. **P-value of <0.01. ***P-value of <0.001.

Abbreviations: ⁺CAU, care as usual; ⁺⁺CMO, care manager organization; ^{^}CI, confidence intervals; ^§DF, degrees of freedom (n-1).