Start improving the quality of care for people with type 2 diabetes through a general practice support program: A cluster randomized trial

Aims: To evaluate the effectiveness of a two-arm quality improvement program (QIP) to support general practice with limited tradition in chronic care on type 2 diabetes patient outcomes. Methods: During 18 months, we performed a cluster randomized trial with randomization of General Practices. The usual QIP (UQIP: 53 GPs, 91.8 patients) merged standard interventions including evidence-based treatment protocol, annual benchmarking, postgraduate education, case-coaching for GPs and patient education. The advanced QIP (AQIP: 67 GPs, 1577 patients) introduced additional interventions focussing on intensified follow-up, shared care and patient behavioural changes. Main outcomes were HbA1c, systolic blood pressure (SBP), and low density lipoprotein cholesterol (LDL-C), analyzed by generalized estimating equations and linear mixed models. Results: In UQIP, endpoints improved significantly after intervention: HbA1c -0.4%, 95% CI [-0.4; -0.3]; SBP -3 mmHg, 95% Cl [-4; -1]; LDL-C -13 mg/dl, 95% CI [-15; -11]. In AQIP, there were no significant additional improvements in outcomes: HbA1c -0.4%, 95% Cl [-0.4; -0.3]; SBP -4 mmHg, 95% CI [-5; -2]; LDL-C -14 mg/dl, 95% CI [-15; -11]. Conclusions: A multifaceted program merging standard interventions in support of general practice induced significant improvements in the quality of diabetes care. Intensified follow-up in AQIP with focus on shared care and patient behaviour changes did not yield additional benefit. (C) 2009 Elsevier Ireland Ltd. All rights reserved