Michele Vitale1, Changchang Xu2, Wendy Lou3, Stacey Horodezny4, Linda Dorado5, Souraya Sidani6, Baiju R Shah7, Enza Gucciardi8. 1. School of Nutrition, Ryerson University, Canada. Electronic address: vita0720@mylaurier.ca. 2. Dalla Lana School of Public Health, University of Toronto, Canada. Electronic address: changchang.xu@mail.utoronto.ca. 3. Dalla Lana School of Public Health, University of Toronto, Canada. Electronic address: wendy.lou@utoronto.ca. 4. Adult Diabetes Programs, Trillium Health Partners, Canada. Electronic address: Stacey.Horodezny@thp.ca. 5. Ryerson University, Canada. Electronic address: ldorado@ryerson.ca. 6. School of Nursing, Ryerson University, Canada. Electronic address: ssidani@ryerson.ca. 7. Department of Medicine, University of Toronto, Canada. Electronic address: baiju.shah@ices.on.ca. 8. School of Nutrition, Ryerson University, Canada. Electronic address: egucciar@ryerson.ca.
Abstract
AIMS: To evaluate the impact of the integration of onsite diabetes education teams in primary care on processes of care indicators according to practice guidelines. METHODS: Teams of nurse and dietitian educators delivered individualized self-management education counseling in 11 Ontario primary care sites. Of the 771 adult patients with HbA1c ≥7% who were recruited in a prospective cohort study, 487 patients attended appointments with the education teams, while the remaining 284 patients did not (usual care group). Baseline demographic, clinical information, and patient care processes (diabetes medical visit, HbA1c test, lipid profile, estimated glomerular filtration rate, and albumin-to-creatinine ratio, measuring blood pressure, performing foot exams, provision of flu vaccine, and referral for dilated retinal exam) were collected from patient charts one year before (pre period) and after (post period) the integration began. A multi-level random effects model was used to analyze the effect of group and period on whether the process indicators were met based on practice guidelines. RESULTS: Compared to the usual care group, patients seen by the education teams had significant improvements on indicators for semi-annual medical visit and annual foot exam. No significant improvements were found for other process of care indicators. CONCLUSIONS: Onsite education teams in primary care settings can potentially improve diabetes management as shown in two process of care indicators: medical visits and foot exams. The results support the benefits of having education teams in primary care settings to increase adherence to practice guidelines.
AIMS: To evaluate the impact of the integration of onsite diabetes education teams in primary care on processes of care indicators according to practice guidelines. METHODS: Teams of nurse and dietitian educators delivered individualized self-management education counseling in 11 Ontario primary care sites. Of the 771 adult patients with HbA1c ≥7% who were recruited in a prospective cohort study, 487 patients attended appointments with the education teams, while the remaining 284 patients did not (usual care group). Baseline demographic, clinical information, and patient care processes (diabetes medical visit, HbA1c test, lipid profile, estimated glomerular filtration rate, and albumin-to-creatinine ratio, measuring blood pressure, performing foot exams, provision of flu vaccine, and referral for dilated retinal exam) were collected from patient charts one year before (pre period) and after (post period) the integration began. A multi-level random effects model was used to analyze the effect of group and period on whether the process indicators were met based on practice guidelines. RESULTS: Compared to the usual care group, patients seen by the education teams had significant improvements on indicators for semi-annual medical visit and annual foot exam. No significant improvements were found for other process of care indicators. CONCLUSIONS: Onsite education teams in primary care settings can potentially improve diabetes management as shown in two process of care indicators: medical visits and foot exams. The results support the benefits of having education teams in primary care settings to increase adherence to practice guidelines.
Authors: Janet E Squires; Danielle Cho-Young; Laura D Aloisio; Robert Bell; Stephen Bornstein; Susan E Brien; Simon Decary; Melissa Demery Varin; Mark Dobrow; Carole A Estabrooks; Ian D Graham; Megan Greenough; Doris Grinspun; Michael Hillmer; Tanya Horsley; Jiale Hu; Alan Katz; Christina Krause; John Lavis; Wendy Levinson; Adrian Levy; Michelina Mancuso; Steve Morgan; Letitia Nadalin-Penno; Andrew Neuner; Tamara Rader; Wilmer J Santos; Gary Teare; Joshua Tepper; Amanda Vandyk; Michael Wilson; Jeremy M Grimshaw Journal: CMAJ Date: 2022-02-28 Impact factor: 16.859