The effect on patient outcomes remained less clear as these were rarely assessed .
Arrangements for follow-up ( organisational intervention ) also showed a favourable effect on process outcomes .
Multiple interventions in which patient education was added or in which the role of the nurse was enhanced also reported favourable effects on patients ' health outcomes .
REVIEW ER 'S CONCLUSIONS Multifaceted professional interventions can enhance the performance of health professionals in managing patients with diabetes .
Organisational interventions that improve regular prompted recall and review of patients ( central computerised tracking systems or nurses who regularly contact the patient ) can also improve diabetes management .
The addition of patient-oriented interventions can lead to improved patient health outcomes .
BACKGROUND Diabetes is a common chronic disease that is increasingly managed in primary care .
Different systems have been proposed to manage diabetes care .
Evaluation of Comprehensive Program for Diabetes Care at Primary Health-Care Level
The Swedish National Board of Health and Welfare published its first diabetes health-care program in 1977 . The impact of the program was evaluated in the Stockholm County after 4 yr . The results showed that the educational program  had reached ≥1 staff member in 86 % of the 104 primary health-care centers ( PHCCs ) . Several organizational changes had taken place as a result of the program . The 10 “ best ” PHCCs were compared with a r and om sample of the centers with regard to patient outcomes . Patients from the 10 best centers had gotten a more comprehensive education , were more knowledgeable about foot care , tested glucose more often , and used less medication . The metabolic control was the same for both groups of patients . The PHCC staffs reported the following roadblocks to change : lack of knowledge of diabetes care , insufficient cooperation between staff members , poor contact with specialists , and absence of guidelines for diabetes care . The staffs in the best centers spent twice as much time in staff meetings and continuing education as those from the r and om sample of centers . The findings led us to formulate a new strategy for the program . The main objective of the new approach is to create organizational changes within the centers . Thus , local knowledge and creativity can be utilized . Preliminary data demonstrate that 84 % of the locally developed plans for reorganization of diabetes care had been accomplished within 1 yr
The effect on patient outcomes remained less clear as these were rarely assessed .
Arrangements for follow-up ( organisational intervention ) also showed a favourable effect on process outcomes .
Multiple interventions in which patient education was added or in which the role of the nurse was enhanced also reported favourable effects on patients ' health outcomes .
REVIEW ER 'S CONCLUSIONS Multifaceted professional interventions can enhance the performance of health professionals in managing patients with diabetes .
Organisational interventions that improve regular prompted recall and review of patients ( central computerised tracking systems or nurses who regularly contact the patient ) can also improve diabetes management .
The addition of patient-oriented interventions can lead to improved patient health outcomes .
BACKGROUND Diabetes is a common chronic disease that is increasingly managed in primary care .
Different systems have been proposed to manage diabetes care .