Skip to main content
Top

06-17-2017 | Healthcare systems | Article

Improving diabetes care at primary care level with a multistrategic approach: results of the DIAPREM programme

Journal: Acta Diabetologica

Authors: Mariana Prestes, Maria A. Gayarre, Jorge F. Elgart, Lorena Gonzalez, Enzo Rucci, Jose M. Paganini, Juan J. Gagliardino, DIAPREM (DIAbetes Primary Care, Registry, Education and Management)

Publisher: Springer Milan

Abstract

Aim

To present results, 1 year postimplementation at primary care level, of an integrated diabetes care programme including systemic changes, education, registry (clinical, metabolic, and therapeutic indicators), and disease management (DIAPREM).

Methods

We randomly selected and trained 15 physicians and 15 nurses from primary care units of La Matanza County (intervention—IG) and another 15 physicians/nurses to participate as controls (control—CG). Each physician–nurse team controlled and followed up 10 patients with type 2 diabetes for 1 year; both groups used structured medical records. Patients in IG had quarterly clinical appointments, whereas those in CG received traditional care. Statistical data analysis included parametric/nonparametric tests according to data distribution profile and Chi-squared test for proportions.

Results

After 12 months, the dropout rate was significantly lower in IG than in CG. Whereas in IG HbA1c, blood pressure and lipid profile levels significantly decreased, no changes were recorded in CG. Drug prescriptions showed no significant changes in IG except a decrease in oral monotherapy.

Conclusions

DIAPREM is an expedient and simple multistrategic model to implement at the primary care level in order to decrease patient dropout and improve control and treatment adherence, and quality of care of people with diabetes.
Literature
1.
Williams R, Van Gaal L, Lucioni C, CODE-2 Advisory Board (2002) Assessing the impact of complications on the costs of Type II diabetes. Diabetologia 45(7):S13–S17. doi:10.​1007/​s00125-002-0859-9 CrossRef
2.
UK Prospective Diabetes Study Group (1998) Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet 352:837–853. doi:10.​1016/​S0140-6736(98)07019-6 CrossRef
3.
UK Prospective Diabetes Study Group (1998) Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. BMJ 317:703–713. doi:10.​1136/​bmj.​317.​7160.​703 CrossRefPubMedCentral
4.
Gaede P, Vedel P, Larsen N, Jensen GV, Parving HH, Pedersen O (2003) Multifactorial intervention and cardiovascular disease in patients with type 2 diabetes. N Engl J Med 348:383–393. doi:10.​1056/​NEJMoa021778 CrossRefPubMed
5.
Gray M, Raikou A McGuire, United Kingdom Prospective Diabetes Study (UKPDS) Group et al (2000) Cost effectiveness of an intensive blood glucose control policy in patients with type 2 diabetes: economic analysis alongside randomized controlled trial (UKPDS 41). BMJ 320:1373–1378CrossRefPubMedPubMedCentral
6.
Gray Clarke P, Farmer A, Holman R, United Kingdom Prospective Diabetes Study (UKPDS) Group (2002) Implementing intensive control of blood glucose concentration and blood pressure in type 2 diabetes in England: cost analysis (UKPDS 63). BMJ 325:860. doi:10.​1136/​bmj.​325.​7369.​860 CrossRefPubMedPubMedCentral
7.
Klonoff DC, Schwartz DM (2000) An economic analysis of interventions for diabetes. Diabet Care 23:390–404. doi:10.​2337/​dc08-S95 CrossRef
8.
Karter AJ, Stevens MR, Herman WH, Translating Research Into Action for Diabetes Study Group et al (2003) Out-of-pocket costs and diabetes preventive services: the Translating Research Into Action for Diabetes (TRIAD) study. Diabet Care 26(8):2294–2299. doi:10.​2337/​diacare.​26.​8.​2294 CrossRef
9.
Beckles GL, Engelgau MM, Narayan KM, Herman WH, Aubert RE, Williamson DF (1998) Population-based assessment of the level of care among adults with diabetes in the U.S. Diabet Care 21:1432–1438. doi:10.​2337/​diacare.​21.​9.​1432 CrossRef
10.
Gagliardino JJ, de la Hera M, Siri F, Grupo de Investigacion de la Red Qualidiab (2001) Evaluación de la calidad de la asistencia al paciente diabético en America Latina. RevPanam Salud Publica/Pan Am J PublicHealth 10:309–317
11.
Saaddine JB, Engelgau MM, Beckles GL, Greg EW, Thompson TJ, Narayan KM (2002) A diabetes report card for the United States: quality of care in the 1990s. Ann Intern Med 136:565–574. doi:10.​7326/​0003-4819-136-8-200204160-00005 CrossRefPubMed
12.
Renders CM, Valk GD, de Sonnaville JJ et al (2003) Quality of care for patients with type 2 diabetes mellitus—a long-term comparison of two quality improvement programmes in the Netherlands. Diabet Med 20:846–852. doi:10.​1046/​j.​1464-5491.​2003.​01009.​x CrossRefPubMed
13.
McGlynn EA, Asch SM, Adams J et al (2003) The quality of health care delivered to adults in the United States. N Engl J Med 348:2635–2645. doi:10.​1056/​NEJMsa022615 CrossRefPubMed
14.
American Diabetes Association (2005) Clinical practice recommendations. Diabet Care 28(Suppl. 1):S1–S79
15.
Commendatore V, Dieuzeide G, Faingold C, DIFAR Academic Committee et al (2013) Registry of people with diabetes in three Latin American countries: a suitable approach to evaluate the quality of health care provided to people with type 2 diabetes. Int J Clin Pract 67(12):1261–1266. doi:10.​1111/​ijcp.​12208 CrossRefPubMed
16.
Larme AC, Pugh JA (1998) Attitudes of primary care providers toward diabetes: barriers to guideline implementation. Diabet Care 21:1391–1396. doi:10.​2337/​diacare.​21.​9.​1391 CrossRef
17.
Anderson RM, Fitzgerald JT, Funnell MM, Gruppen LD (1998) The third version of the Diabetes Attitude Scale. Diabet Care 21:1403–1407. doi:10.​2337/​diacare.​21.​9.​1403 CrossRef
18.
Grant RW, Buse JB, Meigs JB, University HealthSystem Consortium (UHC) Diabetes Benchmarking Project Team (2005) Quality of diabetes care in U.S. academic medical centers: low rates of medical regimen change. Diabet Care 28:337–442. doi:10.​2337/​diacare.​28.​2.​337 CrossRef
19.
Weingarten SR, Henning JM, Badamgarav E et al (2002) Intervention used in disease management programmes for patients with chronic illness—Which ones work? Meta-analysis of published reports. BMJ 325:925. doi:10.​1136/​bmj.​325.​7370.​925 CrossRefPubMedPubMedCentral
20.
Prestes M, Gayarre MA, Elgart JF, Gonzalez L, Rucci E, Gagliardino JJ, DIAPREM (DIAbetes Primary Care, Registry, Education and Management) (2017) Multistrategic approach to improve quality of care of people with diabetes at the primary care level: study design and baseline data. Prim Care Diabet 11(2):193–200. doi:10.​1016/​j.​pcd.​2016.​12.​002 CrossRef
21.
Ferrante D, Linetzky B, Konfino J, King A, Virgolini M, Laspiur S (2011) Encuesta Nacional de Factores de Riesgo 2009: evolución de la epidemia de enfermedades crónicas no transmisibles en Argentina Estudio de corte transversal. Rev Argent Salud Pública 2(6):34–41
22.
Sociedad Argentina de Diabetes (1998) Programa de Capacitación Diabetológica para Médicos Generalistas (PROCAMEG). Rev Soc Argent Diabet 32:205–210
23.
Blonde L, Aschner P, Bailey C, Ji L, Leiter LA, Matthaei S, Global Partnership for Effective Diabetes Management (2017) Gaps and barriers in the control of blood glucose in people with type 2 diabetes. Diabet Vasc Dis Res 14(3):172–183CrossRef
24.
Owens DR, Monnier L, Barnett AH (2017) Future challenges and therapeutic opportunities in type 2 diabetes: changing the paradigm of current therapy. Diabet Obes Metab (Epub ahead of print)
25.
Lu S, Harris MF (2013) Prevention of diabetes and heart disease-patient perceptions on risk, risk assessment and the role of their GP in preventive care. Aust Fam Physician 42:328–331PubMed
26.
Posadzki P, Mastellos N, Ryan R et al (2016) Automated telephone communication systems for preventive healthcare and management of long-term conditions. Cochrane Database Syst Rev 12:CD009921. doi:10.​1002/​14651858.​CD009921.​pub2 PubMed
27.
Vachon B, Désorcy B, Gaboury I et al (2015) Combining administrative data feedback, reflection and action planning to engage primary care professionals in quality improvement: qualitative assessment of short term program outcomes. BMC Health Serv Res 18(15):391. doi:10.​1186/​s12913-015-1056-0 CrossRef
28.
Seidu S, Walker NS, Bodicoat DH, Davies MJ, Khunti K (2016) A systematic review of interventions targeting primary care or community based professionals on cardio-metabolic risk factor control in people with diabetes. Diabet Res Clin Pract 113:1–13. doi:10.​1016/​j.​diabres.​2016.​01.​022 CrossRef
29.
Health Quality Ontario (2013) Specialized nursing practice for chronic disease management in the primary care setting: an evidence-based analysis. Ont Health Technol Assess Ser 13:1–66
30.
Gagliardino JJ, Lapertosa S, Pfirter G, PRODIACOR et al (2013) Clinical, metabolic and psychological outcomes and treatment costs of a prospective randomized trial based on different educational strategies to improve diabetes care (PRODIACOR). Diabet Med 30(9):1102–1111. doi:10.​1111/​dme.​12230 Epub 2013 Jun 7 CrossRefPubMed
31.
Gagliardino JJ, Arrechea V, Assad D et al (2013) Type 2 diabetes patients educated by other patients perform at least as well as patients trained by professionals. Diabet Metab Res Rev 29(2):152–160. doi:10.​1002/​dmrr.​2368 CrossRef
32.
Motta LA, Shephard MD, Brink J, Lawson S, Rheeder P (2017) Point-of-care testing clinic in South Africa. Prim Care Diabet 11:248–253. doi:10.​1016/​j.​pcd.​2016.​09.​008 Epub ahead of print CrossRef
33.
Spaeth BA, Shephard MD, Schatz S (2014) Point-of-care testing for haemoglobin A1c in remote Australian Indigenous communities improves timeliness of diabetes care. Rural Remote Health 14:2849PubMed
34.
Donabedian A (2005) Evaluating the quality of medical care. Milbank Q 83:691–729CrossRefPubMedPubMedCentral
35.
Tricco AC, Ivers NM, Grimshaw JM et al (2012) Effectiveness of quality improvement strategies on the management of diabetes: a systematic review and meta-analysis. Lancet 379(9833):2252–2261CrossRefPubMed

Be confident that your patient care is up to date

Medicine Matters is being incorporated into Springer Medicine, our new medical education platform. 

Alongside the news coverage and expert commentary you have come to expect from Medicine Matters diabetes, Springer Medicine's complimentary membership also provides access to articles from renowned journals and a broad range of Continuing Medical Education programs. Create your free account »