title: Medication intensification in diabetes in rural primary care: a cluster-randomised effectiveness trial.
abstract: OBJECTIVE
  To determine the effectiveness of a provider-based intervention to improve medication intensification among patients with diabetes.
  
  
  METHODS
  Effectiveness cluster-randomised trial. Baseline and follow-up cross-sections of diabetes physicians' patients.
  
  
  METHODS
  Eleven U.S. Southeastern states, 2006-2008.
  
  
  METHODS
  205 Rural primary care physicians, 95 completed the study.
  
  
  METHODS
  Multicomponent interactive intervention including web-based continuing medical education (CME), performance feedback and quality improvement tools.
  
  
  METHODS
  Medication intensification, a dose increase of an existing medication or the addition of a new class of medication for glucose, blood pressure and lipids control on any of the three most recent office visits.
  
  
  RESULTS
  Of 364 physicians attempting to register, 102 were randomised to the intervention and 103 to the control arms; 95 physicians (intervention, n=48; control, n=47) provided data on their 1182 of their patients at baseline (intervention, n=715; control, n=467) and 945 patients at follow-up (intervention, n=479; control, n=466). For A1c control, medication intensification increased in both groups (intervention, pre 26.4% vs post 32.6%, p=0.022; control, pre 24.8% vs post 31.1%, p=0.033) (intervention, adjusted OR (AOR) 1.37; 95% CI 1.06 to 1.76; control, AOR 1.41 (95% CI 1.06 to 1.89)); however, we observed no incremental benefit solely due to the intervention (group-by-time interaction, p=0.948). Among patients with the worst glucose control (A1c >9%), intensification increased in both groups (intervention, pre 34.8% vs post 62.5%, p=0.002; control, pre 35.7% vs post 61.4%, p=0.008).
  
  
  CONCLUSIONS
  A wide-reach, low-intensity, web-based interactive multicomponent intervention had no significant incremental effect on medication intensification for control of glucose, blood pressure or lipids for patients with diabetes of physicians practising in the rural Southeastern USA.
  
  
  BACKGROUND
  NCT00403091.
authors.affiliation: The University of Alabama at Birmingham, Birmingham, Alabama, USA.
authors.forename: Katherine L
authors.initials: KL
authors.lastname: Billue
authors.forename: Monika M
authors.initials: MM
authors.lastname: Safford
authors.forename: Amanda H
authors.initials: AH
authors.lastname: Salanitro
authors.forename: Thomas K
authors.initials: TK
authors.lastname: Houston
authors.forename: William
authors.initials: W
authors.lastname: Curry
authors.forename: Yongin
authors.initials: Y
authors.lastname: Kim
authors.forename: Jeroan J
authors.initials: JJ
authors.lastname: Allison
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Estrada