Start improving the quality of care for people with type 2 diabetes through a general practice support program: a cluster randomized trial.
OBJECTIVE
To evaluate the effectiveness of a two-arm quality improvement program (QIP) to support general practice with limited tradition in chronic care on type 2 diabetes patient outcomes.


METHODS
During 18 months, we performed a cluster randomized trial with randomization of General Practices. The usual QIP (UQIP: 53 GPs, 918 patients) merged standard interventions including evidence-based treatment protocol, annual benchmarking, postgraduate education, case-coaching for GPs and patient education. The advanced QIP (AQIP: 67 GPs, 1577 patients) introduced additional interventions focussing on intensified follow-up, shared care and patient behavioural changes. Main outcomes were HbA1c, systolic blood pressure (SBP), and low density lipoprotein cholesterol (LDL-C), analyzed by generalized estimating equations and linear mixed models.


RESULTS
In UQIP, endpoints improved significantly after intervention: HbA1c -0.4%, 95% CI [-0.4; -0. 3]; SBP -3mmHg, 95% CI [-4; -1]; LDL-C -13mg/dl, 95% CI [-15; -11]. In AQIP, there were no significant additional improvements in outcomes: HbA1c -0.4%, 95% CI [-0.4; -0.3]; SBP -4mmHg, 95% CI [-5; -2]; LDL-C -14mg/dl, 95% CI [-15; -11].


CONCLUSIONS
A multifaceted program merging standard interventions in support of general practice induced significant improvements in the quality of diabetes care. Intensified follow-up in AQIP with focus on shared care and patient behaviour changes did not yield additional benefit.
Goderis
Geert
G
Department of General Practice, Katholieke Universiteit Leuven, Leuven, Belgium. geert.goderis@skynet.be
Borgermans
Liesbeth
L
Grol
Richard
R
Van Den Broeke
Carine
C
Boland
Benoit
B
Verbeke
Geert
G
Carbonez
An
A
Mathieu
Chantal
C
Heyrman
Jan
J
D000368:Aged; D000369:Aged, 80 and over; D016000:Cluster Analysis; D003924:Diabetes Mellitus, Type 2 / Q000191:economics / Q000628:therapy*; D019317:Evidence-Based Medicine / Q000191:economics; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D010353:Patient Education as Topic / Q000191:economics; D010817:Physician-Patient Relations; D011787:Quality of Health Care / Q000191:economics*; D016896:Treatment Outcome