title: Improved quality of Type 2 diabetes care following electronic feedback of treatment status to general practitioners: a cluster randomized controlled trial.
abstract: OBJECTIVE
  To evaluate the effect of an electronic feedback system to general practitioners on quality of Type 2 diabetes care.
  
  
  METHODS
  A cluster randomized, controlled trial with 15 months follow-up. Eighty-six general practices (158 general practitioners) in a Danish county caring for 2458 people 40-70 years old with Type 2 diabetes were randomized to receive or not to receive electronic feedback on quality of care. People with Type 2 diabetes were identified using a validated algorithm. Primary end-points were processes of care according to guidelines on prescriptions redeemed for Type 2 diabetes treatments, measuring of glycated haemoglobin and cholesterol and visits to ophthalmologists. Secondary end-points were changes in level of glycated haemoglobin and serum cholesterol. Data were analysed using generalized linear models accounting for clustering at practice level.
  
  
  RESULTS
  During follow-up, people with Type 2 diabetes in the intervention group more often redeemed recommended prescriptions than people in the control group, respectively, as follows: oral antidiabetic treatment (32.8 vs. 12.0%, P =0.002), insulin treatment (33.8 vs. 12.4%, P < 0.001), lipid-lowering medication (38.3 vs. 18.6%, 0.004) and blood pressure medication (27.6 vs. 16.3%, P = 0.026). There were no differences in mean glycated haemoglobin and serum cholesterol between the two groups.
  
  
  CONCLUSIONS
  Electronic feedback to general practitioners on the quality of Type 2 diabetes care resulted in significantly improved quality regarding processes of care according to guidelines. It was not possible to demonstrate any effect on secondary end-point measures within the follow-up period. Electronic feedback on quality of diabetes care can be effective in improving adherence to treatment according to evidence-based guidelines.
authors.affiliation: Department of General Practice Research, Aarhus University, Denmark. trine.guldberg@alm.au.dk
authors.forename: T L
authors.initials: TL
authors.lastname: Guldberg
authors.forename: P
authors.initials: P
authors.lastname: Vedsted
authors.forename: J K
authors.initials: JK
authors.lastname: Kristensen
authors.forename: T
authors.initials: T
authors.lastname: Lauritzen
mesh_terms: D000328:Adult; D000368:Aged; D000465:Algorithms; D003695:Delivery of Health Care / Q000592:standards*; D003718:Denmark; D003924:Diabetes Mellitus, Type 2 / Q000523:psychology / Q000628:therapy*; D030141:Feedback, Psychological; D005260:Female; D058006:General Practice / Q000592:standards*; D006442:Glycated Hemoglobin; D006801:Humans; D008297:Male; D008875:Middle Aged; D010821:Physicians, Family / Q000592:standards*; D017410:Practice Guidelines as Topic; D011787:Quality of Health Care / Q000592:standards*
chemical_list: D006442:Glycated Hemoglobin