[Effectiveness and efficiency of ambulatory diabetes education programs. A comparison of specialty practice and general practice].
OBJECTIVE
The increasing incidence of NIDDM requires adequate proof of the effectiveness and efficiency of out-patient programmes for diabetics. This study aimed at examining which of the two methods may promise the better results under controlled expenses--modifications of the present standardized diabetes education program in the general practice or specifically developed diabetes education programme in specialist diabetes practice.


METHODS
75 diabetics took part in the different out-patient diabetes education programmes at one special practice for diabetology or one of seven general practitioner practices, respectively. The self-developed intensive diabetes education programme of the special practice led by two specialists in diabetology and a dietician was compared with the diabetes education programme of the general practices performed by a doctor's assistant. 38 diabetics in eight training groups at the specialist for diabetology and 37 patients in seven training groups at the general practices were instructed. 32 patients in total (18 patients at the specialist practice and 14 patients at the general practices) additionally received an evaluated support programme which addressed psychosocial impediments related to the topics of a structured diabetes therapy. All patients were asked to complete a questionnaire before, right after, 3 and 6 months after the programme. Weight and glycosylated haemoglobin (HbA1c) were measured before, 3 and 6 months after the programme.


RESULTS
The mean weight and glycosylated hemoglobin of all groups decreased as expected. However, the patients of the general practices achieved more lasting reduction of these objective parameters. All patients stated impairments of their quality of life, but the patients of the specialist practice felt more impaired. The motivational support programme achieved only few positive results.


CONCLUSIONS
The standardized diabetes education programme of the general practices and the more intensive and expensive diabetes education programme achieved equally valuable results. Regarding time and expenses, the standardized diabetes education programme may be the more efficient method of NIDDM out-patient education.
Haisch
J
J
jochen.haisch@medizin.uni-ulm.de
Remmele
W
W
D000368:Aged; D000553:Ambulatory Care; D003922:Diabetes Mellitus, Type 1 / Q000523:psychology / Q000628:therapy*; D003924:Diabetes Mellitus, Type 2 / Q000523:psychology / Q000628:therapy*; D003927:Diet, Diabetic; D005194:Family Practice; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team; D010349:Patient Compliance / Q000523:psychology; D010353:Patient Education as Topic; D015397:Program Evaluation; D011788:Quality of Life; D012944:Social Support; D013038:Specialization; D016896:Treatment Outcome
D006442:Glycated Hemoglobin