Start improving the quality of care for people with type 2 diabetes through a general practice support program: A cluster randomized trial

Goderis, Geert; Borgermans, Liesbeth; Grol, Richard; Van Den Broeke, Carine; Boland, Benoit; Verbeke, Geert; Carbonez, An; Mathieu, Chantal; Heyrman, Jan

doi:10.1016/j.diabres.2009.12.012

« Previous Next »Diabetes Research and Clinical Practice
Volume 88, Issue 1 , Pages 56-64, April 2010

Start improving the quality of care for people with type 2 diabetes through a general practice support program: A cluster randomized trial

Geert Goderis
- Department of General Practice, Katholieke Universiteit Leuven, Belgium
- Corresponding author at: Katholieke Universiteit Leuven, Department of General Practice (Academisch Centrum voor Huisartsgeneeskunde), Kapucijnenvoer 33/J Bus 7001, 3000 Leuven, Belgium. Tel.: +32 16 337468; fax: +32 16 337480.
Liesbeth Borgermans
- Department of General Practice, Katholieke Universiteit Leuven, Belgium
Richard Grol
- Scientific Institute for the Quality of Healthcare, Radboud University Nijmegen, The Netherlands
Carine Van Den Broeke
- Department of General Practice, Katholieke Universiteit Leuven, Belgium
Benoit Boland
- Médecine Interne, Cliniques Universitaires St-Luc, Belgium
Geert Verbeke
- Biostatistical Centre, Katholieke Universiteit Leuven, Belgium
An Carbonez
- Leuven Statistics Research Centre, Katholieke Universiteit Leuven, Belgium
Chantal Mathieu
- Endocrinology, University Hospitals Leuven, Belgium
- Senior authors who contributed equally to this work.
Jan Heyrman
- Department of General Practice, Katholieke Universiteit Leuven, Belgium
- Senior authors who contributed equally to this work.

Received 5 March 2009; received in revised form 1 October 2009; accepted 8 December 2009. published online 04 January 2010.

Abstract

Aims

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.

Abbreviations: ADA, American diabetes association, AQIP, advanced quality improvement program, BMI, body mass index, CHD, coronary heart disease, CI, confidence interval, GP, general practitioner, GPRN, general practice registry network, GEE, generalized estimating equations, HDL-C, high density lipoprotein cholesterol, LDL-C, low density lipoprotein cholesterol, NIHDI, National Institute for Health and Disability Insurance, SBP, systolic blood pressure, Tot-C, total cholesterol, T2DM, type 2 diabetes mellitus, TTM, trans theoretical model of change, UQIP, usual quality improvement program