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Controlled trial of an intervention to improve cholesterol management in diabetes patients in remote Aboriginal communities.

Abstract：

OBJECTIVES:Aboriginal communities have a high prevalence of diabetes and heart disease, and limited resources to address them. The objective of this study was to test the effectiveness of prioritizing care with audit and feedback on cholesterol management of diabetic patients. STUDY DESIGN:A controlled before-after intervention trial was conducted among health care providers in Oji-Cree reserves in Sioux Lookout Zone, Ontario. Two communities were randomized to receive an interactive educational workshop and chart audit with feedback on cholesterol management; 2 control communities received usual care. METHODS:The primary outcome measure used was the proportion of patients on statins, and the secondary outcome measure was the proportion of patients with LDL>2.5 mmol/L or TC/HDL>4.0 on statins. Outcomes were assessed by chart review at baseline and 10 months post-intervention. RESULTS:Patients in the 2 intervention communities (n=170) and the 2 controls (n=170) were comparable at baseline. The intervention did not increase the proportion of diabetic patients on statins overall or in the subset of patients with elevated cholesterol. The proportion of patients with elevated cholesterol on statins went from 46% to 53% (p=0.48) in the intervention group and from 47% to 50% (p=0.25) in the control group. CONCLUSIONS:Audit and feedback listing patients requiring treatment did not increase statin prescription rates in diabetic patients in remote Aboriginal settings. This may be due to elevated baseline rates, the low intensity of feedback and the constraints of the practice environment, such as low staffing and high staff turnover.

journal_name

Int J Circumpolar Health

journal_title

International journal of circumpolar health

authors

Bhattacharyya O,Harris S,Zwarenstein M,Barnsley J

doi

10.3402/ijch.v69i4.17629

subject

Has Abstract

pub_date

2010-09-01 00:00:00

pages

333-43

issue

4

eissn

1239-9736

issn

2242-3982

pii

1028

journal_volume

69

pub_type

杂志文章,随机对照试验

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