Task delegation and computerized decision support reduce coronary heart disease risk factors in type 2 diabetes patients in primary care.
BACKGROUND
Reducing cardiovascular risk in patients with diabetes mellitus type 2 (DM2) is important in diabetes care. However, treating patients according to clinical guidelines appears to be difficult. Delegating routine tasks to a practice nurse combined with computerized decision support systems (CDSS) may be helpful. The objective was to study the effectiveness of practice nurse-managed CDSS for diabetes care on improving cardiovascular risk factors in DM2 patients.


METHODS
In 113 primary care practices (n = 7,893 DM2 patients) across the Netherlands, the diabetes care protocol (DCP) was assessed in a before-after study, lasting 1 year. All practices implemented DCP, which is characterized by delegation of routine tasks in diabetes care to a practice nurse, software that supports diabetes management, medical decisions, and benchmarking (CDSS). All DM2 patients treated by their primary care physician were asked to attend the program. Primary outcome was the percentage of patients achieving treatment targets: hemoglobin A1c (HbA1c) <or=7%, blood pressure <or= 150/85 mm Hg, and total cholesterol <or= 5 mmol/L.


RESULTS
The percentage of DM2 patients who achieved targets increased significantly, from 60.6% to 66.5% for HbA1c, from 48.7% to 61.9% for blood pressure, and from 47.4 % to 60.6% for total cholesterol. The percentage of patients achieving all three targets increased from 15.3% to 26.9% (all P < 0.01).


CONCLUSIONS
Delegating routine tasks in diabetes care to a practice nurse combined with CDSS and benchmarking helps achieve treatment goals for HbA1c, blood pressure, and cholesterol and reduce cardiovascular risk of DM2 patients in primary care.
Cleveringa
Frits G W
FG
Julius Centre for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands. f.g.w.cleveringa@umcutrecht.nl
Gorter
Kees J
KJ
van den Donk
Maureen
M
Pijman
Peter L W
PL
Rutten
Guy E H M
GE
D000368:Aged; D001794:Blood Pressure; D003327:Coronary Disease / Q000453:epidemiology* / Q000503:physiopathology; D032022:Delegation, Professional / Q000706:statistics & numerical data*; D003922:Diabetes Mellitus, Type 1 / Q000150:complications* / Q000453:epidemiology / Q000503:physiopathology; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000453:epidemiology / Q000503:physiopathology; D003925:Diabetic Angiopathies / Q000453:epidemiology* / Q000503:physiopathology; D001330:Electronic Data Processing; D005006:Ethnicity; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D011320:Primary Health Care; D011446:Prospective Studies; D012307:Risk Factors