Tools You Can Use The American Association of Diabetes Educators is an organization of professionals, including nurses, registered dietitian nutritionists, and pharmacists, who provide diabetes education to patients with or at risk for diabetes. Patients with diabetes also have other preventive health needs, such as screening for colorectal or breast cancer, that must also be tracked. The major change in therapy among patients in the integrated model was progression from 2 or more oral drugs or bedtime insulin to 2 or more insulin injections per day. They had been in practice an average of 14. Self-monitoring of blood glucose 10. We rotate the material every 2 months.
In both groups, more patients met the target values goals for lipid profile compared to baseline. Significance was set at the 5% level 2-tailed. Audits and feedback are effective agents for changing physicians behavior. J Fam Pract 34:457-63, 1992. Methods: A nurse trained to follow approved detailed treatment algorithms glycemia and dyslipidemia algorithms for both models plus a hypertension algorithm for the integrated model was given prescription authority. Eley, Elizabeth Patterson, Jacqui Young, Paul P.
Comorbid Health Problems Table 2 displays the diabetes-related complications and other comorbid health problems reported by patients in the study. Ann Intern Med 124:149-52, 1996. Find all of the news and departments you love from the print issue archived for easy online access, along with special Web-only content. Recruitment of clinicians began in July 2000. The patients in the intervention group were cared for by practice nurses who treated glucose levels, blood pressure and lipid profile according to a specified protocol. Table 5 shows the relationship between HbA 1c level and the diabetes treatment strategies, including oral medications and insulin. All patients were seen at least every 3 months.
The control group received conventional care from a general practitioner. We will briefly discuss why diabetes is a difficult disease for a primary care physician to manage. While these interventions are the least effective, they are the most common ways that organizations disseminate their guidelines. In our own system, we provide pocket cards to all primary care providers Figure 1. The 95 participating clinicians had an average age of 45. Oxford, The Cochrane Library, issue 1, 1998.
Results from multilevel models showing associations with these 4 control outcomes are given in Tables 7 and 8. A reduction in frequency of hypoglycemia was also found, as was a reduction in frequency of office visits. Slightly more than one third 34. Measures Clinicians completed a self-administered questionnaire at the initiation of the study. Finally, treatment was strongly related to HbA 1c levels, where more aggressive treatment was associated with higher HbA 1c levels. Finally, when the 3 control targets were considered together, 45 7. Further studies are needed to confirm a similar experience in the primary care setting.
Pocket card for diabetes mellitus 4. Dickey and Petitti showed that patient-held mini-records improved compliance with preventive services. At that point, patients were seen every 3 months to determine if the A1C goal of less than 7. In summary, patients with type 2 diabetes are commonly cared for in primary care settings and have a substantial burden of diabetes-related comorbidity. Macrovascular complications coronary artery disease, strokes, and peripheral arterial disease are increased 2-fold to 4-fold in patients with diabetes mellitus versus age-matched control subjects without diabetes.
Coprimary outcomes were weight loss of at least 15 kg and remission of diabetes, defined as an HbA1c of less than 6. Offices without a computerized reminder system may find pocket cards and flow sheets easy and effective to implement, while other practices may have the resources to implement a computerized tracking system or an electronic medical record with decision support. They grouped the interventions into weak, moderately effective, and relatively strong interventions. Moderately effective interventions include audits and feedback. Only one-third of the fellows were aware of the guidelines before the study began.
Ultimately, one quarter of patients in the nonintegrated model were using insulin mostly bedtime insulin only , while three quarters of patients in the integrated model were using insulin mostly intensified regimens. Improving Performance in a Primary Care Office Alan M. Patients with type 2 diabetes often have acute or chronic comorbid health problems that force the clinician to prioritize and address the most pressing or symptomatic problems first. Get patients involved in their care. If that value was 7.