title: A clinical trial of chronic care diabetic clinics in general practice in the United Arab Emirates: a preliminary analysis.
abstract: Control of diabetes mellitus is a high priority for primary health care systems. One innovative method of diabetes care delivery is the use of structured diabetes care in primary care. This includes the use of chronic care diabetes clinics or mini-clinics operated by general practitioners in primary care. There is limited experience with this model in non-Western settings. This study sought to evaluate a multi-component structured approach to diabetes care in primary care including chronic care diabetes clinics in a newly developed country in the Arabian Gulf. The study design used was a controlled before-after methodology. Three primary health centers were chosen for the intervention with six of the remaining clinics in a Health District being used as controls. A multifaceted intervention was initiated in the intervention clinics composed of chronic care diabetes clinics, a diabetic flow chart, and educational programs for clinic nurses and doctors and patients. The study intervention took place over a period of 18 months with three diabetic outcomes (fasting blood glucose, blood pressure and cholesterol) and adherence to seven diabetes guidelines being compared for the year prior to the intervention and during the last 12 months of the intervention period. Knowledge and satisfaction questionnaires were also administered to intervention and control subjects at the end of the study. In this study, 219 subjects were enrolled (130 males and 89 females). They had a mean age of 51.6 years and a mean of 3.1 years of formal education. Of these 109 were enrolled in one of three clinics that had a chronic care diabetes clinic and 110 were enrolled in one of the six control clinics. Subjects had diabetes for a mean of 7.8 +/- 4.8 years and the majority was treated with pharmacological therapy. Baseline characteristics in the intervention and the control clinics were similar with the exception of younger age (p = 0.01) and a trend for more males (p = 0.06) in the intervention clinics. There was a statistically insignificant change noted with the intervention in the three clinical outcomes studied (fasting blood glucose, blood pressure and cholesterol) both in comparison to the control group before and after and within the intervention group. However most changes noted were in the expected direction of improvement; six of the seven guidelines were statistically improved in the intervention group when compared with the control group. Within the intervention group, adherence with five of seven guidelines was also statistically significantly increased with the remaining guidelines showing a trend in favor of improvement (fasting blood glucose measurements (p = 0.07) and urine determinations for protein (p = 0.07)). Knowledge questionnaire scores were similar between the intervention and control groups on completion of the study but 2 of 4 items on a satisfaction scale were statistically significantly higher in the intervention group. The intervention described in this setting was successful in improving adherence to diabetes guidelines and increased some aspects of satisfaction with diabetes care. The intervention did not result in a statistically significant improvement in clinical outcomes but changes noted were in the expected direction of improvement. The significant improvement in adherence to diabetes guidelines suggests that this intervention is a promising model for diabetes care for newly developed countries.
authors.affiliation: Department of Family Medicine, Faculty of Medicine and Health Sciences, United Arab Emirates University, Al Ain, UAE. rreed@uaeu.ac.ae
authors.forename: R L
authors.initials: RL
authors.lastname: Reed
authors.forename: A O
authors.initials: AO
authors.lastname: Revel
authors.forename: A
authors.initials: A
authors.lastname: Carter
authors.forename: H F
authors.initials: HF
authors.lastname: Saadi
authors.forename: E V
authors.initials: EV
authors.lastname: Dunn
mesh_terms: D001786:Blood Glucose / Q000032:analysis; D001794:Blood Pressure; D002784:Cholesterol / Q000097:blood; D003920:Diabetes Mellitus / Q000628:therapy*; D004493:Education; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010044:Outpatient Clinics, Hospital; D010349:Patient Compliance; D010353:Patient Education as Topic; D017060:Patient Satisfaction; D017410:Practice Guidelines as Topic; D011320:Primary Health Care; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014479:United Arab Emirates
chemical_list: D001786:Blood Glucose; D002784:Cholesterol