title: Diabetes in rural towns: effectiveness of continuing education and feedback for healthcare providers in altering diabetes outcomes at a population level: protocol for a cluster randomised controlled trial.
abstract: BACKGROUND
  Type 2 diabetes is one of the fastest growing chronic diseases internationally. The health complications associated with type 2 diabetes can be prevented, delayed, or improved via early diagnosis and effective management. This research aims to examine the impact of a primarily web-based educational intervention on the diabetes care provided by general practitioners (GPs) in rural areas, and subsequent patient outcomes. A population-level approach to outcome assessment is used, via whole-town de-identified pathology records.
  
  
  METHODS
  The study uses a cluster randomised controlled trial with rural communities as the unit of analysis. Towns from four Australian states were selected and matched on factors including rurality, population size, proportion of the population who were Indigenous Australians, and socio-economic status. Eleven pairs of towns from two states were suitable for the trial, and one town from each pair was randomised to the experimental group. GPs in the towns allocated to the experimental group are offered an intervention package comprising education on best practice diabetes care via an on-line active learning module, a moderated discussion forum, access to targeted and specialist advice through an on-line request form, and town-based performance feedback on diabetes monitoring and outcomes. The package is offered via repeated direct mail.
  
  
  CONCLUSIONS
  The benefits of the outcomes of the trial are described along with the challenges and limitations associated with the methodology.
  
  
  BACKGROUND
  Australian New Zealand Clinical Trials Registry: ACTRN12611000553976.
authors.affiliation: Health Behaviour Research group, Priority Research Centre for Health Behaviour, School of Medicine and Public Health, University of Newcastle, HMRI Building, Callaghan, NSW 2308, Australia. Chris.Paul@newcastle.edu.au
authors.forename: Christine L
authors.initials: CL
authors.lastname: Paul
authors.forename: Leon
authors.initials: L
authors.lastname: Piterman
authors.forename: Jonathan
authors.initials: J
authors.lastname: Shaw
authors.forename: Catherine
authors.initials: C
authors.lastname: Kirby
authors.forename: Robert W
authors.initials: RW
authors.lastname: Sanson-Fisher
authors.forename: Mariko L
authors.initials: ML
authors.lastname: Carey
authors.forename: Jennifer
authors.initials: J
authors.lastname: Robinson
authors.forename: Patrick
authors.initials: P
authors.lastname: McElduff
authors.forename: Isaraporn
authors.initials: I
authors.lastname: Thepwongsa
mesh_terms: D000328:Adult; D000419:Albuminuria / Q000517:prevention & control; D001315:Australia; D001786:Blood Glucose / Q000378:metabolism; D016000:Cluster Analysis; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000628:therapy*; D004496:Education, Continuing / Q000379:methods*; D004650:Employee Performance Appraisal; D055317:Evidence-Based Practice; D005246:Feedback; D058006:General Practice / Q000193:education*; D006442:Glycated Hemoglobin / Q000378:metabolism; D019983:Guideline Adherence; D006801:Humans; D006949:Hyperlipidemias / Q000517:prevention & control; D020407:Internet; D017410:Practice Guidelines as Topic; D012423:Rural Health; D016896:Treatment Outcome
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin