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Interventions to improve the management of diabetes mellitus in primary care, outpatient and community settings

Creator:

Renders, C. A., Valk, G. D., Griffin, S. J., Wagner, E., van Eijk, J. T. and Assendelft, W. J. J.

Subject Keywords: Health professionals, Organisational interventions, Continuity of care, Diabetes
Topic: Chronic Conditions
Conditions
Diabetes
Chronic Conditions
Type: Article
Region: International (other)
Description:

Diabetes is a common chronic disease that is increasingly managed in primary care. Different systems have been proposed to manage diabetes care. Objectives To assess the effects of different interventions, targeted at health professionals or the structure in which they deliver care, on the management of patients with diabetes in primary care, outpatient and community settings. Randomised trials (RCTs), controlled clinical trials (CCTs), controlled before and after studies (CBAs) and interrupted time series (ITS) analyses of professional, financial and organisational strategies aimed at improving care for people with Type 1 or Type 2 diabetes were used. The participants were health care professionals, including physicians, nurses and pharmacists. The outcomes included objectively measured health professional performance or patient outcomes, and self-report measures with known validity and reliability. Forty-one studies were included involving more than 200 practices and 48,000 patients. Twenty-seven studies were RCTs, 12 were CBAs, and two were ITS. The studies were heterogeneous in terms of interventions, participants, settings and outcomes. The methodological quality of the studies was often poor. In all studies the intervention strategy was multifaceted. In 12 studies the interventions were targeted at health professionals, in nine they were targeted at the organisation of care, and 20 studies targeted both. In 15 studies patient education was added to the professional and organisational interventions. A combination of professional interventions improved process outcomes. 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.

Date:

23/10/2000

Rights: © The Cochrane Collaboration
Suggested citation:

Renders, C. A., Valk, G. D., Griffin, S. J., Wagner, E., van Eijk, J. T. and Assendelft, W. J. J.. (2000) Interventions to improve the management of diabetes mellitus in primary care, outpatient and community settings [Online]. Available from: http://publichealthwell.ie/node/4409 [Accessed: 20th November 2019].

  

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