Article type
Year
Abstract
Introduction:
Objectives: In diabetes care a wide range of interventions targeting professional behaviour or the structure of care have been implemented in the last few years. This review aims to identify (parts of) interventions that effectively improve the management of patients with diabetes mellitus in primary care, outpatient and community settings.
Methods: A systematic computerized literature search in Medline, Embase and Cinahl was conducted, supplemented with citation tracking. Studies were selected if an intervention strategic was implemented to improve provider practice or patient outcomes for non-hospitalised patients with type 1 or type 2 diabetes, including organisational, professional and financial interventions. The intervention had to be targeted at health care professionals. Only studies which met the minimum study design and methodological inclusion criteria of the Effective Practice and Organisation of Care review group (EPOC) were included. Selection of relevant studies, assessment of the quality of methods and data extraction are carried out by two reviewers independently. Given the likely heterogeneity of interventions, settings and patient populations, a pooled analysis will not be undertaken.
Results: A total of 30 studies were included: 15 randomized controlled trials (RCT), 13 controlled before-after (CBA) studies and 2 interrupted time series (ITS). Most studies dealt with a combination of professional and organisational interventions. In particular centralised, computer-based systems for prompted recall and more regular review of patients were often part of the complex interventions that were implemented. Many studies introduced special trained nurses to guarantee the continuity of care. No studies on effectiveness of financial interventions were found. The follow-up period in most studies was less than 2 years.
Discussion: A discussion of the main methodological problems encountered and conclusions on the effectiveness of various types of interventions will be presented at the 7th Cochrane Colloquium.
Objectives: In diabetes care a wide range of interventions targeting professional behaviour or the structure of care have been implemented in the last few years. This review aims to identify (parts of) interventions that effectively improve the management of patients with diabetes mellitus in primary care, outpatient and community settings.
Methods: A systematic computerized literature search in Medline, Embase and Cinahl was conducted, supplemented with citation tracking. Studies were selected if an intervention strategic was implemented to improve provider practice or patient outcomes for non-hospitalised patients with type 1 or type 2 diabetes, including organisational, professional and financial interventions. The intervention had to be targeted at health care professionals. Only studies which met the minimum study design and methodological inclusion criteria of the Effective Practice and Organisation of Care review group (EPOC) were included. Selection of relevant studies, assessment of the quality of methods and data extraction are carried out by two reviewers independently. Given the likely heterogeneity of interventions, settings and patient populations, a pooled analysis will not be undertaken.
Results: A total of 30 studies were included: 15 randomized controlled trials (RCT), 13 controlled before-after (CBA) studies and 2 interrupted time series (ITS). Most studies dealt with a combination of professional and organisational interventions. In particular centralised, computer-based systems for prompted recall and more regular review of patients were often part of the complex interventions that were implemented. Many studies introduced special trained nurses to guarantee the continuity of care. No studies on effectiveness of financial interventions were found. The follow-up period in most studies was less than 2 years.
Discussion: A discussion of the main methodological problems encountered and conclusions on the effectiveness of various types of interventions will be presented at the 7th Cochrane Colloquium.