title: Education integrated into structured general practice care for Type 2 diabetic patients results in sustained improvement of disease knowledge and self-care.
abstract: OBJECTIVE
  The objective of this study was to study the effectiveness of structured care with and without integrated education with regard to patients' knowledge, self-care behaviour and disease perception.
  
  
  METHODS
  Four diabetes care programmes implemented in a daily primary care setting were compared, two based on structured care and two on education integrated into structured care. Measurements were taken at baseline and after 6 and 12 months.
  
  
  RESULTS
  The study included 243 patients with Type 2 diabetes mellitus treated by a general practitioner (mean age 64.0 years; diabetes duration 7.1 years). The level of patients' disease knowledge increased in all programmes, was preserved at follow-up and differed between programmes with a specific educational component (37%) on one hand and the non-educational programmes (11%) on the other (P < 0.001). The percentage of patients performing self-care behaviour increased in all programmes, but more so in the programmes with an educational component. In addition, an increase in the frequency of self-care behaviour was observed, whereas no change in disease perception was found. In cross sectional analyses disease knowledge and self-care behaviour were positively related (partial correlation coefficient: 0.35; P < 0.001 adjusted for age, sex, level of education and duration of diabetes).
  
  
  CONCLUSIONS
  The results indicate that primary care programmes which integrated education into structured care are able to improve both Type 2 diabetic patients' disease knowledge and their self-care behaviour. These improvements endured after the completion of the programmes, which suggests that they initiate lasting changes in the way patients handle their disease.
authors.affiliation: Julius Center for Patient Oriented Research, Utrecht University, The Netherlands.
authors.forename: I J
authors.initials: IJ
authors.lastname: van den Arend
authors.forename: R P
authors.initials: RP
authors.lastname: Stolk
authors.forename: G E
authors.initials: GE
authors.lastname: Rutten
authors.forename: G J
authors.initials: GJ
authors.lastname: Schrijvers
mesh_terms: D000368:Aged; D001519:Behavior; D015190:Blood Glucose Self-Monitoring; D003924:Diabetes Mellitus, Type 2 / Q000628:therapy*; D005260:Female; D006801:Humans; D019359:Knowledge; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic; D010465:Perception; D012648:Self Care