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.
RCT Entities:
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 diabetespatient 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.
Authors: Anthony W Russell; Maria Donald; Samantha J Borg; Jianzhen Zhang; Letitia H Burridge; Robert S Ware; Nelufa Begum; H David McIntyre; Claire L Jackson Journal: Diabetologia Date: 2018-10-03 Impact factor: 10.122
Authors: Viviane F A Van Casteren; Nathalie H E Bossuyt; Sarah J S Moreels; Geert Goderis; Katrien Vanthomme; Johan Wens; Etienne W De Clercq Journal: Arch Public Health Date: 2015-07-13
Authors: Sonja M Reichert; Stewart B Harris; Jordan W Tompkins; Judith Belle-Brown; Meghan Fournie; Michael Green; Han Han; Jyoti Kotecha; Selam Mequanint; Jann Paquette-Warren; Sharon Roberts; Grant Russell; Moira Stewart; Amardeep Thind; Susan Webster-Bogaert; Richard Birtwhistle Journal: BMJ Open Diabetes Res Care Date: 2017-08-29
Authors: Jianzhen Zhang; Letitia Burridge; Kimberley A Baxter; Maria Donald; Michele M Foster; Samantha A Hollingworth; Robert S Ware; Anthony W Russell; Claire L Jackson Journal: Trials Date: 2013-11-12 Impact factor: 2.279