[Impact of guidelines diffusion and information feedback in diabetes management. Assessment of general practitioner support program conducted by the French Mutualité Sociale Agricole (MSA)].
OBJECTIVE
To assess the impact of HAS (French national health authority) physician guides dedicated to diabetes on general practice, and the impact of additional individual information feedback.


METHODS
51 MSA funds participated in the study, consisting in two periods (April 2006-March 2007 and April 2007-March 2008). In total, 91 case physicians (who benefited from an individual information feedback) and 126 control physicians (who only received the HAS guide), having at least five diabetic patients covered by the agricultural health insurance scheme (Régime agricole) were included. A Chi2 test and a t-test were performed to compare both groups and both periods, respectively.


RESULTS
In the control group, the most significant variations between both periods involved the annual follow-up performed by a specialist (cardiologist, ophtalmologist), whereas the differences in therapeutic treatment remained stable or almost stable, statins and aspirin being still underused in patients at increased risk of cardiovascular disease. Finally, the progression in laboratory follow-up remained slow: approximately 1-2% per year according to parameters. The additional information feedback (active group) only led to a significantly different change in cardiac follow-up and the use of aspirin as a platelet suppressive agent, as compared to the mere sending of the HAS guide (control group).


CONCLUSIONS
The impact of HAS guides was limited and uneven in the management of diabetic patients, and was not conclusively strengthened by the additional information feedback. The form and diffusion of good practice recommendations and feedback should be reviewed to allow for a better appropriation.
Van Bockstael
Vincent
V
Caisse centrale de Mutualité Sociale Agricole, Bagnolet. vanbockstael.vincent@ccmsa.msa.fr
Sabin
Nicolas
N
Crochet
Benoît
B
D003920:Diabetes Mellitus / Q000628:therapy*; D005194:Family Practice; D005602:France; D006801:Humans; D017410:Practice Guidelines as Topic; D015397:Program Evaluation