Controlled trial of a multifaceted intervention for improving quality of care for rural patients with type 2 diabetes.
OBJECTIVE
Despite good evidence and clinical practice guidelines, studies document that treatment of type 2 diabetes is less than optimal. Lack of resources or limited access may put patients in rural communities at particular risk for suboptimal care.


METHODS
We conducted a prospective, before/after study with concurrent controls to assess the effectiveness of a multidisciplinary diabetes outreach service (intervention) for improving the quality of care for rural patients with type 2 diabetes. Our intervention consisted of six monthly visits by a traveling team of specialist physicians, nurses, dieticians, and a pharmacist. The core of this service was specialist-to-rural primary care physician academic group detailing. Two comparable regions in Northern Alberta were randomly allocated to control or intervention. Data were collected before and 6 months after intervention in a representative volunteer sample. The primary outcome was a 10% improvement in any one of the following: blood pressure, total cholesterol, or HbA(1c).


RESULTS
Our analysis included 200 intervention and 179 control subjects; 14 subjects were at all three primary outcome targets at baseline. The intervention was associated with a trend toward improvement in primary outcome at 6 months (44% intervention vs. 37% control; odds ratio 1.32, 95% CI 0.87-1.99). The intervention was associated with a significant improvement in blood pressure (42% intervention vs. 25% control, P = 0.004); however, there were only small, nonsignificant changes in cholesterol or HbA(1c). The intervention was associated with a significant increase in satisfaction with diabetes care. Multivariate adjustment for baseline differences between intervention and control subjects did not affect any of the main results.


CONCLUSIONS
A diabetes outreach service has the potential to improve the quality of diabetes care for rural patients. Future studies need to involve longer timelines and larger sample sizes.
Majumdar
Sumit R
SR
Department of Medicine, University of Alberta, Edmonton, Canada.
Guirguis
Lisa M
LM
Toth
Ellen L
EL
Lewanczuk
Richard Z
RZ
Lee
T K
TK
Johnson
Jeffrey A
JA
D000368:Aged; D000416:Alberta; D003159:Community-Institutional Relations; D003924:Diabetes Mellitus, Type 2 / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D015397:Program Evaluation; D011446:Prospective Studies; D011787:Quality of Health Care; D019035:Rural Health Services / Q000458:organization & administration / Q000592:standards*; D012424:Rural Population