Introducing quality clusters in general practice - a qualitative study of the experiences of cluster coordinators.

BACKGROUND: In 2018, the concept of clusters was introduced as a new model for data-driven quality improvement in general practice in Denmark. However, there is little research on the development and implementation of general practice clusters. The study explores how the cluster coordinators responsible for leading the clusters forward enacted and experienced their role during the early years of the clusters with attention to the challenges and enablers perceived in the process. METHODS: Qualitative, semi-structured interviews with 25 cluster coordinators from clusters that had carried out at least two meetings on a specific professional topic. The coordinators represented clusters of varying sizes and different geographic locations. Key topics in the interview guide were the development and structure of the cluster, the role of the coordinator, obtainment of data for the meetings, the role of external support, the form and content of the meetings, the participation and engagement of the members. A thematic analysis - shaped by the original aims and categories of the study while also being open to emerging themes - was performed on the transcribed interview material. RESULTS: Important enablers in the process of developing the clusters included the positive engagement of the GPs, the support offered by regional quality units and a national quality organisation for general practice, and the funding provided by the formal cluster framework. Challenges initially included setting up the clusters administratively and translating the open cluster concept into a local, workable model; and later obtaining relevant data for the cluster meetings and facilitating peer discussions about the data. CONCLUSION: The coordinators generally experienced that the development of the clusters had progressed relatively fast with engagement from most of the participating GPs. Still, challenges with data obtainment, data analysis, and facilitation will have to be addressed ongoingly. Future research should investigate learning processes at the cluster meetings and how the clusters impact clinical practice and collaborative relations between general practice and other health care providers.

Urbanization, migration and alcohol use in a population of Greenland Inuit.

OBJECTIVE: To analyse the effects of migration and urbanisation on alcohol intake among a population of Greenland Inuit. STUDY DESIGN: Population-based cross-sectional study of 4,139 Inuit randomly selected from Denmark and four areas of western Greenland. Data collection was based on interviews and self-administered questionnaires. METHODS: The association between different aspects of alcohol intake (quantity of intake, occasional heavy drinking, and the modified CAGE questionnaire) and place of living were analysed using a chi-square test and logistic regression analysis. RESULTS: The population living in Denmark had a higher mean alcohol intake than those living in Greenland. Drinking above the sensible drinking limits (21 drinks per week for men and 14 drinks per week for women; where one drink contains 12 g alcohol) was also more prevalent in the population living in Denmark, whereas a higher proportion of those living in Greenland was abstaining. In contrast to the higher alcohol intake in the population living in Denmark, a higher proportion of individuals with episodes of heavy drinking (binge drinking), was observed in both large and small communities in Greenland. A higher proportion of positive results on the modified CAGE test, measuring alcohol dependence, were also seen in large communities in Greenland. We found no statistically significant differences in alcohol intake between Inuit living in large and small communities in Greenland. When comparing Inuit living in Denmark according to length of stay in Denmark, we found a significantly increase in prevalence of binge drinking with length of stay, while no significant variation with length of stay was found for other alcohol parameters. CONCLUSION: Our findings suggest that the alcohol intake among Inuit, living in Denmark and in Greenland respectively, differs in relation to total intake, drinking patterns and a measure of alcohol dependence. Whether this may be attributed to urbanization, or to migration, is not clear.