Complex professional interventions improved the process of care , but the effect on patient outcomes remained less clear because such outcomes were rarely assessed .
Organizational interventions that facilitated the structured and regular review of patients also showed a favorable effect on process measures .
Complex interventions in which patient education was added and /or the role of a nurse was enhanced led to improvements in patient outcomes as well as the process of care .
CONCLUSIONS Multifaceted professional interventions and organizational interventions that facilitate structured and regular review of patients were effective in improving the process of care .
The addition of patient education to these interventions and the enhancement of the role of nurses in diabetes care led to improvements in patient outcomes and the process of care
The scope for cardiovascular disease risk factor intervention among people with diabetes mellitus in England: a population-based analysis from the Health Surveys for England 1991-94.
AIMS To examine the scope for cardiovascular disease risk factor intervention among diabetic patients in Engl and was examined using data from the Health Surveys for Engl and 1991 - 94 . This evaluation included calculating the proportion who require  lipid lowering therapy  according to the St and ing Medical Advisory Committee ( SMAC ) guidelines . METHODS The Health Survey for Engl and is an annual , nationwide household-based in which anthropomorphic data , blood pressure , lipids and details of cardiovascular risk factors are collected from households after r and om stratification for geographical and socio-economic factors within a population sample of 39639 adults , 970 ( 2.3 % ) diabetic subjects were identified . RESULTS Overall , 51 % of those with diabetes had hypertension  ( systolic blood pressure > or = 160 mmHg or a diastolic BP > or = 95 mmHg or being on antihypertensive therapy ) , 27 % were  obese  ( body mass index > or = 30 kg/m2 ) and 19 % were current smokers . One-third of those with hypertension were untreated and less than one-half of those on treatment had their hypertension controlled to below 160/ 95 mmHg . More than one-quarter had poor glycaemic control ( glycated Hb>11 % or an HbA1c>7.5 % ) . Of those aged < 70 years , 29 % required  lipid lowering therapy  according to the SMAC guidelines and almost all ( 94 % ) of these were not on treatment . An analysis showed that , because the SMAC guidelines do not require high density lipoprotein ( HDL ) cholesterol to be measured , their use is likely to result in substantial underestimation of the need for  lipid lowering  , particularly in diabetic women . CONCLUSION In Engl and , among those with diabetes there is considerable unmet need for cardiovascular risk factor intervention , particularly for hypertension and raised cholesterol . With this baseline established , future improvements can be monitored
Complex professional interventions improved the process of care , but the effect on patient outcomes remained less clear because such outcomes were rarely assessed .
Organizational interventions that facilitated the structured and regular review of patients also showed a favorable effect on process measures .
Complex interventions in which patient education was added and /or the role of a nurse was enhanced led to improvements in patient outcomes as well as the process of care .
CONCLUSIONS Multifaceted professional interventions and organizational interventions that facilitate structured and regular review of patients were effective in improving the process of care .
The addition of patient education to these interventions and the enhancement of the role of nurses in diabetes care led to improvements in patient outcomes and the process of care