title: Controlled trial of an intervention to improve cholesterol management in diabetes patients in remote Aboriginal communities.
abstract: OBJECTIVE
  Aboriginal communities have a high prevalence of diabetes and heart disease, and limited resources to address them. The objective of this study was to test the effectiveness of prioritizing care with audit and feedback on cholesterol management of diabetic patients.
  
  
  METHODS
  A controlled before-after intervention trial was conducted among health care providers in Oji-Cree reserves in Sioux Lookout Zone, Ontario. Two communities were randomized to receive an interactive educational workshop and chart audit with feedback on cholesterol management; 2 control communities received usual care.
  
  
  METHODS
  The primary outcome measure used was the proportion of patients on statins, and the secondary outcome measure was the proportion of patients with LDL>2.5 mmol/L or TC/HDL>4.0 on statins. Outcomes were assessed by chart review at baseline and 10 months post-intervention.
  
  
  RESULTS
  Patients in the 2 intervention communities (n=170) and the 2 controls (n=170) were comparable at baseline. The intervention did not increase the proportion of diabetic patients on statins overall or in the subset of patients with elevated cholesterol. The proportion of patients with elevated cholesterol on statins went from 46% to 53% (p=0.48) in the intervention group and from 47% to 50% (p=0.25) in the control group.
  
  
  CONCLUSIONS
  Audit and feedback listing patients requiring treatment did not increase statin prescription rates in diabetic patients in remote Aboriginal settings. This may be due to elevated baseline rates, the low intensity of feedback and the constraints of the practice environment, such as low staffing and high staff turnover.
authors.affiliation: Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, M5B 1M8, Canada.
authors.forename: Onil
authors.initials: O
authors.lastname: Bhattacharyya
authors.forename: Stewart
authors.initials: S
authors.lastname: Harris
authors.forename: Merrick
authors.initials: M
authors.lastname: Zwarenstein
authors.forename: Jan
authors.initials: J
authors.lastname: Barnsley
mesh_terms: D003920:Diabetes Mellitus; D005246:Feedback; D005260:Female; D006801:Humans; D006937:Hypercholesterolemia / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D009864:Ontario; D010353:Patient Education as Topic; D044382:Population Groups