TY - JOUR
T1 - An endocrinologist-supported intervention aimed at providers improves diabetes management in a primary care site
T2 - Improving primary care of African Americans with diabetes (IPCAAD) 7
AU - Phillips, Lawrence S.
AU - Ziemer, David C.
AU - Doyle, Joyce P.
AU - Barnes, Catherine S.
AU - Kolm, Paul
AU - Branch, William T.
AU - Caudle, Jane M.
AU - Cook, Curtiss B.
AU - Dunbar, Virginia G.
AU - El-Kebbi, Imad M.
AU - Gallina, Daniel L.
AU - Hayes, Risa P.
AU - Miller, Christopher D.
AU - Rhee, Mary K.
AU - Thompson, Dennis M.
AU - Watkins, Clyde
PY - 2005/10
Y1 - 2005/10
N2 - OBJECTIVE - Management of diabetes is frequently suboptimal in primary care settings, where providers often fail to intensify therapy when glucose levels are high, a problem known as clinical inertia. We asked whether interventions targeting clinical inertia can improve outcomes. RESEARCH DESIGN AND METHODS - A controlled trial over a 3-year period was conducted in a municipal hospital primary care clinic in a large academic medical center. We studied all patients (4,138) with type 2 diabetes who were seen in continuity clinics by 345 internal medicine residents and were randomized to be control subjects or to receive one of three interventions. Instead of consultative advice, the interventions were hard copy computerized reminders that provided patient-specific recommendations for management at the time of each patient's visit, individual face-to-face feedback on performance for 5 min every 2 weeks, or both. RESULTS - Over an average patient follow-up of 15 months within the intervention site, improvements in and final HbA1c (AlC) with feedback + reminders (ΔAlC 0.6%, final AlC 7.46%) were significantly better than control (ΔAlC 0.2%, final AlC 7.84%, P < 0.02); changes were smaller with feedback only and reminders only (P = NS vs. control). Trends were similar but not significant with systolic blood pressure (sBP) and LDL cholesterol. Multivariable analysis showed that the feedback intervention independently facilitated attainment of American Diabetes Association goals for both AlC and sBP. Over a 2-year period, overall glycemic control improved in the intervention site but did not change in other primary care sites (final AlC 7.5 vs. 8.2%, P < 0.001). CONCLUSIONS - Feedback on performance aimed at overcoming clinical inertia and given to internal medicine resident primary care providers improves glycemic control. Partnering generalises with diabetes specialists may be important to enhance diabetes management in other primary care settings.
AB - OBJECTIVE - Management of diabetes is frequently suboptimal in primary care settings, where providers often fail to intensify therapy when glucose levels are high, a problem known as clinical inertia. We asked whether interventions targeting clinical inertia can improve outcomes. RESEARCH DESIGN AND METHODS - A controlled trial over a 3-year period was conducted in a municipal hospital primary care clinic in a large academic medical center. We studied all patients (4,138) with type 2 diabetes who were seen in continuity clinics by 345 internal medicine residents and were randomized to be control subjects or to receive one of three interventions. Instead of consultative advice, the interventions were hard copy computerized reminders that provided patient-specific recommendations for management at the time of each patient's visit, individual face-to-face feedback on performance for 5 min every 2 weeks, or both. RESULTS - Over an average patient follow-up of 15 months within the intervention site, improvements in and final HbA1c (AlC) with feedback + reminders (ΔAlC 0.6%, final AlC 7.46%) were significantly better than control (ΔAlC 0.2%, final AlC 7.84%, P < 0.02); changes were smaller with feedback only and reminders only (P = NS vs. control). Trends were similar but not significant with systolic blood pressure (sBP) and LDL cholesterol. Multivariable analysis showed that the feedback intervention independently facilitated attainment of American Diabetes Association goals for both AlC and sBP. Over a 2-year period, overall glycemic control improved in the intervention site but did not change in other primary care sites (final AlC 7.5 vs. 8.2%, P < 0.001). CONCLUSIONS - Feedback on performance aimed at overcoming clinical inertia and given to internal medicine resident primary care providers improves glycemic control. Partnering generalises with diabetes specialists may be important to enhance diabetes management in other primary care settings.
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U2 - 10.2337/diacare.28.10.2352
DO - 10.2337/diacare.28.10.2352
M3 - Article
C2 - 16186262
AN - SCOPUS:25644432124
SN - 0149-5992
VL - 28
SP - 2352
EP - 2360
JO - Diabetes care
JF - Diabetes care
IS - 10
ER -