A multifaceted intervention in support of diabetes treatment guidelines: A cont trial

Department of Health Services, University of Washington Seattle, Seattle, Washington, United States
Diabetes Research and Clinical Practice (Impact Factor: 2.54). 11/2002; 58(1):27-36. DOI: 10.1016/S0168-8227(02)00100-6
Source: PubMed


in an academic family practice clinic, we performed a controlled trial of a multifaceted intervention versus usual care for managing diabetes. Providers received didactic training and computerized compliance feedback to support staged diabetes management, an evidenced-based approach to diabetes care.
one firm of the clinic practice received the intervention, the other served as the control group during a 14-month baseline period and a 14-month study period. HbA1(c) was the principal outcome measure.
there was a significant 0.71% difference in change in HbA1(c) values between the intervention and control firms (P=0.02). The subgroup with the greatest improvement in HbA1(c) was those subjects who started the intervention with a HbA1(c) above 8%. The overall improvement in glycemic control could not be explained by differences in visit frequency or the aggressiveness of drug therapy. There were no changes in healthcare utilization or costs between the two firms.
in an academic family practice clinic, a multifaceted intervention in support of diabetes treatment guidelines modestly improved glycemic control without incurring additional costs. The improvement was mostly due to mitigation of the natural deterioration in control usually seen. Further efforts are required to involve all patients in co-managing their diabetes.

Download full-text


Available from: Scott D Ramsey, Apr 10, 2014
  • Source
    • "Enrollees exhibited a significant reduction of 0.7% in A1C levels from 2007 to 2008. This is in accordance with the result of other studies that reported reduction in A1C levels in the range of 0.7% -0.9% [11] [13] [15] [28] [29]. A metaanalysis of randomized control trials indicated that pharmacist-based programs reduce A1C levels by 0.76% in comparison to standard care [30]. "

    Full-text · Article · Jan 2013
  • [Show abstract] [Hide abstract]
    ABSTRACT: A tactile hearing aid was modified to test the ability of lateral inhibition to sharpen the perceived tactile display. The aid was based on amplitude- and time-quantized speech. The digital frequencies in the processes signal were detected and displayed via a linear array of electrodes using biphasic constant current pulses. In the lateral inhibition scheme the active electrode inhibits other electrodes that are plus or minus three electrodes away from it. Inhibition and no-inhibition schemes were tested with the two schemes in a forced choice test. No statistically significant difference could be detected between the two display schemes for the test material
    No preview · Article · Jan 1989
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: To assess short-term clinical, economic, and humanistic outcomes of pharmaceutical care services (PCS) for patients with diabetes in community pharmacies. Intention-to-treat, pre-post cohort-with-comparison group study. Twelve community pharmacies in Asheville, N.C. Eighty-five patients with diabetes who were employees, dependents, or retirees from two self-insured employers; community pharmacists who completed a diabetes certificate program and received reimbursement for PCS. Patients scheduled consultations with pharmacists over 7 to 9 months. Pharmacists provided education, self-monitored blood glucose (SMBG) meter training, clinical assessment, patient monitoring, follow-up, and referral. Group 1 patients began receiving PCS in March 1997, and group 2 patients began in March 1999. Change from baseline in the two employer groups in glycosylated hemoglobin (A1c) values, serum lipid concentrations, health-related quality of life (HRQOL), satisfaction with pharmacy services, and health care utilization and costs. Patients used SMBG meters at home, stored all readings, and brought their meters with them to 87% of the 317 PCS visits (3.7 visits per patient). Patients' A1c concentrations were significantly reduced, and their satisfaction with pharmacy services improved significantly. Patients experienced no change in HRQOL. From the payers' perspective, there was a significant dollars 52 per patient per month increase in diabetes costs for both groups, with PCS fees and diabetes prescriptions accounting for most of the increase. In contrast, both groups experienced a nonsignificant but economically important 29% decrease in nondiabetes costs and a 16% decrease in all-diagnosis costs. A clear temporal relationship was found between PCS and improved A1c, improved patient satisfaction with pharmacy services, and decreased all-diagnosis costs. Findings from this study demonstrate that pharmacists provided effective cognitive services and refute the idea that pharmacists must be certified diabetes educators to help patients with diabetes improve clinical outcomes.
    Full-text · Article · Mar 2003 · Journal of the American Pharmaceutical Association
Show more