Family Practice Advance Access first published online on August 21, 2008
This version published online on September 8, 2008
Family Practice, doi:10.1093/fampra/cmn045
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Implementation of locally adapted guidelines on type 2 diabetes
a Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht
b Department of Epidemiology, University Medical Center Groningen, Groningen
c Department of Internal Medicine, Gelre Hospital, Gelre, The Netherlands
Correspondence to Rykel van Bruggen, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Street 6.101, PO Box 85060, Utrecht 3508 AB, The Netherlands; Email: j.a.r.vanbruggen{at}umcutrecht.nl
Received 18 September 2007; Revised 25 May 2008; Accepted 7 July 2008.
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Abstract |
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Objective. To assess the effects of a facilitator enhanced multifaceted intervention to implement a locally adapted guideline on the shared care for people with type 2 diabetes.
Methods. During 1 year a cluster-randomized trial was performed in 30 general practices. In the intervention group, nurse facilitators enhanced guideline implementation by analysing barriers to change, introducing structured care, training practice staff and giving performance feedback. Targets for HbA1c%, systolic blood pressure as well as indications for angiotensin converting enzyme/angiotensin receptor blocking agent prescription differed from the national guidelines. In the control group, GPs were asked to continue the care for people with diabetes as usually. Generalized estimating equations were used to control for the clustered design of the study.
Results. In the intervention group, more people were seen on a 3-monthly basis (88% versus 69%, P < 0.001) and more blood pressure and bodyweight measurements were performed every 3 months (blood pressure 83% versus 66%, P < 0.001 and bodyweight 78.9% versus 48.5%, P < 0.001). Apart from a marginal difference in mean cholesterol, differences in HbA1c%, blood pressure, body mass index and treatment satisfaction were not significant.
Conclusion. Multifaceted implementation of locally adapted shared care guidelines did improve the process of diabetes care but hardly changed intermediate outcomes. In the short term, local adaptation of shared care guidelines does not improve the cardiovascular risks of people with type 2 diabetes.
Keywords. Chronic disease management, diabetes, randomized controlled trial.
van Bruggen R, Gorter KJ, Stolk RP, Verhoeven RP and Rutten GEHM. Implementation of locally adapted guidelines on type 2 diabetes. Family Practice 2008; Pages 1–8 of 8.