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Start improving the quality of care for people with type 2 diabetes through a general practice support program: a cluster randomized trial.

Abstract：

AIMS:To evaluate the effectiveness of a two-arm quality improvement program (QIP) to support general practice with limited tradition in chronic care on type 2 diabetes patient outcomes. METHODS:During 18 months, we performed a cluster randomized trial with randomization of General Practices. The usual QIP (UQIP: 53 GPs, 918 patients) merged standard interventions including evidence-based treatment protocol, annual benchmarking, postgraduate education, case-coaching for GPs and patient education. The advanced QIP (AQIP: 67 GPs, 1577 patients) introduced additional interventions focussing on intensified follow-up, shared care and patient behavioural changes. Main outcomes were HbA1c, systolic blood pressure (SBP), and low density lipoprotein cholesterol (LDL-C), analyzed by generalized estimating equations and linear mixed models. RESULTS:In UQIP, endpoints improved significantly after intervention: HbA1c -0.4%, 95% CI [-0.4; -0. 3]; SBP -3mmHg, 95% CI [-4; -1]; LDL-C -13mg/dl, 95% CI [-15; -11]. In AQIP, there were no significant additional improvements in outcomes: HbA1c -0.4%, 95% CI [-0.4; -0.3]; SBP -4mmHg, 95% CI [-5; -2]; LDL-C -14mg/dl, 95% CI [-15; -11]. CONCLUSIONS:A multifaceted program merging standard interventions in support of general practice induced significant improvements in the quality of diabetes care. Intensified follow-up in AQIP with focus on shared care and patient behaviour changes did not yield additional benefit.

journal_name

Diabetes Res Clin Pract

journal_title

Diabetes research and clinical practice

authors

Goderis G,Borgermans L,Grol R,Van Den Broeke C,Boland B,Verbeke G,Carbonez A,Mathieu C,Heyrman J

doi

10.1016/j.diabres.2009.12.012

subject

Has Abstract

pub_date

2010-04-01 00:00:00

pages

56-64

issue

1

eissn

0168-8227

issn

1872-8227

pii

S0168-8227(09)00537-3

journal_volume

88

pub_type

杂志文章,随机对照试验

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