Abstract
Objective
To review the interventions targeting primary care or community based professionals
on glycaemic and cardiovascular risk factor control in people with diabetes.
Research design and methods
A systematic review of randomised controlled trials evaluating the effectiveness of
interventions targeting primary care or community based professionals on diabetes
and cardiovascular risk factor control. We conducted searches in MEDLINE database
from inception up to 27th September 2015. We also retrieved articles related to diabetes
from the Cochrane EPOC database and EMBASE and scanned bibliographies for key articles.
Results
There was heterogeneity in terms of interventions and participants amongst the 30
studies (39,439 patients) that met the inclusion criteria. Nine of the studies focused
on general or family practitioners, five on pharmacists, three on nurses and one each
on dieticians and community workers. Twelve studies targeted multi-disciplinary teams.
Educational interventions did not seem to have a positive impact on HbA1c, systolic
blood pressure or lipid profiles. The use of telemedicine, clinician reminders and
feedback showed mixed results but there was a level of consistency in improvement
in HbA1c when multifaceted interventions on multidisciplinary teams were implemented.
Targeting general or family physicians was largely ineffective in improving the cardiovascular
risk factors considered, except when using a computer application on insulin handling
of type 2 diabetes or customised simulated cases with feedbacks. Similarly, interventions
targeting nurses did not improve outcomes compared to standard care.
Conclusions
Multifaceted professional interventions were more effective than single interventions
targeting single primary or community care professionals in improving glycaemic control.
Keywords
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Article info
Publication history
Published online: January 21, 2016
Accepted:
January 14,
2016
Received:
July 29,
2015
Identification
Copyright
© 2016 Elsevier Ireland Ltd. Published by Elsevier Inc. All rights reserved.
