Clinical trial NCT02229110: Effectiveness of a Computerised Prompt for Primary and Secondary Care Physicians to Refer or Refer Back Type 2 Diabetes Patients
Official title: Effectiveness of a Computerised Prompt for Primary and Secondary Care Physicians to Refer or Refer Back Type 2 Diabetes Patients
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Diabetes Mellitus
Keywords: type 2 diabetes mellitus
e-Health
allocation of care
clinical inertia
quality of care
patient satisfaction
Lead sponsor: UMC Utrecht
Sponsor class: OTHER
First posted: 2014-08-29
Enrollment: 2779
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: HEALTH_SERVICES_RESEARCH

Brief summary: Patients with type 2 diabetes mellitus can receive care in the general practice or at the outpatient clinic. In the region of Amersfoort in The Netherlands, primary care practices and the hospital are connected through Diamuraal to organize the diabetes care in that region. They work in the same electronic medical record, and patients can request access to their own record (called a patient web portal). They set up Diamuraal guidelines, based on the guidelines of the Dutch College of General Practitioners and Internists, on where the patient care needs to be allocated (primary or secondary care), depending on the amount of specific care a patient needs. Despite guidelines, not all patients are treated in the correct place.

Our hypotheses is that when we improve triage we can cause a major shift from treatment in secondary care to primary care and from primary care to self-care by using the patient web portal. Furthermore, patients who needs extra attention due to problems with their diabetes or complications can receive this extra attention due to increased e-consultation between primary care and secondary care and if necessary actually can, during a short time, be treated by an internist. We hope to achieve this by introducing a signal in the electronic medical record. This signal allocates patients according to the guidelines and warns a physician if their patients is not treated according to that guideline. The health care provider can then discuss this situation with his patient. We believe that this leads to shift in allocation of care, in which optimal care is provided and patients are made more aware of their situation which hopefully leads to better self-management and satisfaction.


Eligibility criteria: Inclusion Criteria:

* patients with type 2 diabetes mellitus
* health care provider work within Diamuraal setting

Exclusion Criteria:

- none

Primary outcomes:
measure: The number of participants with change in allocation of care after intervention
timeFrame: One year
Secondary outcomes:
measure: Assembly of reasons by health care providers for not following the guidelines
timeFrame: One year
measure: Change in quality of diabetes care
timeFrame: One year
measure: Change in diabetes treatment satisfaction
timeFrame: One year
measure: Number of participants who meet their treatment goals
timeFrame: One year
Other outcomes:
Locations:
city: Amersfoort
country: Netherlands
facility: Diamuraal-associated GP practices
city: Amersfoort
country: Netherlands
facility: Meander Medical Center
Study officials:
affiliation: UMC Utrecht
name: Guy EH Rutten, MD PhD
role: PRINCIPAL_INVESTIGATOR
affiliation: UMC Utrecht
name: Lioe-Ting Dijkhorst-Oei, MD, PhD
role: STUDY_DIRECTOR
affiliation: UMC Utrecht
name: Maaike CM Ronda, MD
role: STUDY_DIRECTOR
References:
citation: Ronda MC, Dijkhorst-Oei LT, Gorter KJ, Beulens JW, Rutten GE. Differences between diabetes patients who are interested or not in the use of a patient Web portal. Diabetes Technol Ther. 2013 Jul;15(7):556-63. doi: 10.1089/dia.2013.0023. Epub 2013 Jun 18.