“Wonca Europe 2007 conference” WONCA: World Organisation for General Medicine location:Parijs date:17-20 oktober 2007
Objective To evaluate the effectiveness of a two- intensity level quality improvement program on the number of reached targets in type 2 DM patients in general practice. Methods Clustered randomized controlled trial with an 18-month intervention period in a primary care setting in Belgium. The “R” group (53 Primary Care Physicians (PCP), 918 patients) was subjected to intensive re-organisation of care (diabetes support team, care manager, benchmarking feedback and post-graduate education). The “A” group (67 PCP, 1577 patients) received in addition more cost-intensive interventions (patient centred feedback, peer review, education on motivational interviewing, patient (group) education by nurse educators at home and interventions of a health psychologist). Primary therapeutic targets were HbA1c < 7%; LDL-Cholesterol < 100 mg/dl ; Systolic Blood Pressure 130 mm Hg. Statistical analyses were performed using a multilevel, multivariate model. Results Final registration included 120 PCP (67 “A” and 53 “R”) and 2255 patients (1448 ”A” and 807 “R”). The proportion of patients on target before and after intervention evolved from respectively 53 to 66% and 55 to 68% (Hba1c), from 41 to 55% and 42 to 60% (LDL-C), from 48 to 53% and 50 tot 60% (SBP). Time evolution was significant for both groups and all parameters (p<0.0001) but no significant differences were noticed between groups. Conclusion. Reorganization of care results into significant positive outcomes and thus better quality of care. Cost-intensive interventions show no additional significant effect.