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 h and ling of type 2 diabetes or customised simulated cases with feedbacks .
Similarly , interventions targeting nurses did not improve outcomes compared to st and ard care .
Multifaceted professional interventions were more effective than single interventions targeting single primary or community care professionals in improving glycaemic control
OBJECTIVE To review the interventions targeting primary care or community based professionals on glycaemic and cardiovascular risk factor control in people with diabetes .
A cluster randomised trial of educational messages to improve the primary care of diabetes
Background Regular laboratory test monitoring of patient parameters offers a route for improving the quality of chronic disease care . We evaluated the effects of brief educational messages attached to laboratory test reports on diabetes care . Methods A programme of cluster r and omised controlled trials was set in primary care practice s in one primary care trust in Engl and . Participants were the primary care practice s ' constituent healthcare professionals and patients with diabetes . Interventions comprised brief educational messages added to paper and electronic primary care practice laboratory test reports and introduced over two phases . Phase one messages , attached to Haemoglobin A1c ( HbA1c ) reports , targeted glycaemic and cholesterol control . Phase two messages , attached to albumin : creatinine ratio ( ACR ) reports , targeted blood pressure ( BP ) control , and foot inspection . Main outcome measures comprised practice mean HbA1c and cholesterol levels , diastolic and systolic BP , and proportions of patients having undergone foot inspections . Results Initially , 35 out of 37 eligible practice s participated . Outcome data were available for a total of 8,690 patients with diabetes from 32 practice s. The BP message produced a statistically significant reduction in diastolic BP ( -0.62 mmHg ; 95 % confidence interval -0.82 to -0.42 mmHg ) but not systolic BP ( -0.06 mmHg , -0.42 to 0.30 mmHg ) and increased the odds of achieving target BP control ( odds ratio 1.05 ; 1.00 , 1.10 ) . The foot inspection message increased the likelihood of a recorded foot inspection ( incidence rate ratio 1.26 ; 1.18 to 1.36 ) . The glycaemic control message had no effect on mean HbA1c ( increase 0.01 % ; -0.03 to 0.04 ) despite increasing the odds of a change in likelihood of HbA1c tests being ordered ( OR 1.06 ; 1.01 , 1.11 ) . The cholesterol message had no effect ( decrease 0.01 mmol/l , -0.04 to 0.05 ) . Conclusions Three out of four interventions improved intermediate outcomes or process of diabetes care . The diastolic BP reduction approximates to relative reductions in mortality of 3 % to 5 % in stroke and 3 % to 4 % in ischaemic heart disease over 10 years . The lack of effect for other outcomes may , in part , be explained by difficulties in bringing about further improvements beyond certain thresholds of clinical performance . Trial Registration Current Controlled Trials , IS RCT N2186314
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 h and ling of type 2 diabetes or customised simulated cases with feedbacks .
Similarly , interventions targeting nurses did not improve outcomes compared to st and ard care .
Multifaceted professional interventions were more effective than single interventions targeting single primary or community care professionals in improving glycaemic control
OBJECTIVE To review the interventions targeting primary care or community based professionals on glycaemic and cardiovascular risk factor control in people with diabetes .