A pilot quality improvement intervention in patients with diabetes and hypertension in primary care settings of Cyprus

Samoutis, George; Soteriades, Elpidoforos S.; Stoffers, Jelle; Philalithis, Αnastas; Delicha, Eumorphia Maria; Lionis, Christos

doi:10.1093/fampra/cmq009

Cited by 18 publications

(21 citation statements)

References 30 publications

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“…We found that there were significant improvements in the absolute change in the proportion of PCPs' adherence to T2DM CPG in the intervention group with regard to the recording of BMI, performing foot examination, performing funduscopy/fundus photography, monitoring renal profile, measuring urine protein, and giving lifestyle modification and self-management advice. These findings were similar to a randomized controlled trial involving 504 patients (278 patients in the intervention practices and 226 patients in the control practices) which showed that the mean results of three annual performance measures (urine protein testing, funduscopy, and foot examination) had improved at 18-month follow-up in the intervention group as compared to the control group [32]. Another study of 208 patients showed that 85.5% had more than twice HbA1c test done in a year, 93.6% had lipid profiles test, and 100% had foot examinations following a multifaceted intervention [33].…”

Section: Discussionsupporting

confidence: 81%

Effectiveness of the EMPOWER-PAR Intervention on Primary Care Providers’ Adherence to Clinical Practice Guideline on the Management of Type 2 Diabetes Mellitus: A Pragmatic Cluster Randomised Controlled Trial

Daud¹,

Ramli²,

Abdul-Razak³

et al. 2020

Open Access Maced J Med Sci

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AIM: The objective of this study was to evaluate the effectiveness of the EMPOWER- participatory action research (PAR) intervention, a multifaceted strategy based on the chronic care model (CCM) on primary care providers (PCP)’ adherence to type 2 diabetes mellitus (T2DM) clinical practice guideline (CPG) in the Malaysian primary care setting. METHODS: This was a pragmatic cluster randomized controlled trial –PAR conducted in ten public primary care clinics in Malaysia. Five clinics were randomly selected to provide the EMPOWER-PAR intervention for 1 year and another five clinics continued with usual care. The outcome measure was the absolute change in the proportion of PCP’s adherence to T2DM CPG captured using the “Indicators of Care Pro forma,” based on the recommendation by the Malaysian CPG on the Management of T2DM. Data were collected from the patients’ medical records, at baseline and at 1-year follow-up; and were analyzed using mixed method model. RESULTS: A total of 888 patients were recruited at baseline; 471 were in the intervention and 417 were in the control group. There was no significant demographic difference between the two groups at baseline except for ethnicity. At 1-year, 455 (96.6%) and 406 (97.3%) patients in the intervention and control groups completed the study, respectively. There were significant improvements in the absolute change in the proportion of PCPs’ adherence to T2DM CPG in the intervention group compared to the control group at 1-year follow-up in several indicators of care. These included the recording of BMI (0.6% vs. −1.8%, p<0.001); performing foot examination (2.4% vs. 0.6%, p<0.001); performing funduscopy/fundus photography (1.5% vs. 0.3%, p<0.001); monitoring renal profile (0.9% vs. −0.6%, p=0.001); measuring urine protein (1.2% vs. 0.6%, p<0.001), and giving lifestyle modification and self-management advice (1.2% vs. −0.3%, p<0.001) in the intervention versus control groups, respectively. CONCLUSION: The EMPOWER-PAR intervention has been proven to be effective in improving the PCPs’ adherence to T2DM CPG in several indicators of care. Findings from this study provided objective evidence of the effectiveness of multifaceted intervention based on the CCM in the Malaysian public primary care setting. TRIAL REGISTRATION: Registered with: ClinicalTrials.gov: NCT01545401. Date of registration: 1st March 2012.

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Section: Discussionsupporting

confidence: 81%

Effectiveness of the EMPOWER-PAR Intervention on Primary Care Providers’ Adherence to Clinical Practice Guideline on the Management of Type 2 Diabetes Mellitus: A Pragmatic Cluster Randomised Controlled Trial

Daud¹,

Ramli²,

Abdul-Razak³

et al. 2020

Open Access Maced J Med Sci

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“…Multi-faceted interventions, grounded on several theories and models, have been developed in Cyprus to provide better quality of care for hypertensive patients in primary care settings [ 76 ]. Such approaches, like one incorporating both an electronic medical record system and guidelines for managing clinical diseases, showed positive outcomes for hypertensive patients on many measures including blood pressure, total cholesterol and patient satisfaction [ 77 ]. Whilst a majority of physicians in Cyprus are aware of and adhere to guidelines on managing hypertension, there is great scope to improve not only their awareness of specific European scientific guidelines (e.g.…”

Section: Discussionmentioning

confidence: 99%

The contribution of Cyprus to non-communicable diseases and biomedical research from 2002 to 2013: implications for evidence-based health policy

Pallari

Lewison

Pallari

et al. 2018

Health Res Policy Sys

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BackgroundNon-communicable diseases (NCDs) are the leading causes of disease burden and mortality at the European level and in Cyprus. This research was conducted to map the research activities of Cypriot institutions in five NCDs, namely oncology, cardiovascular diseases, diabetes, mental health and respiratory conditions.MethodsFor the period 2002–2013, research in Cyprus was assessed on its biomedical outputs and compared to the rest of Europe relative to their GDP. The research output in the five NCDs was obtained and contrasted to their respective disease burdens. The results from each of the five NCDs showed the amount of cross-country collaboration with other researchers from other European countries and from the rest of the world, and the research level of the papers on a clinical to basic scale. For each NCD field the research application was assessed, whereas for oncology the research type was also assessed. Information was collected on the development of clinical guidelines, on Cypriot newspapers reporting on medical and policy documents and advisory committees’ output as well as research and funding organisations available in Cyprus, for potential evaluation of impact in health policy on the five NCDs.ResultsCypriot biomedical research output appeared appropriate in volume compared with its wealth and the expected value from a regression line for other European countries. However, it was focused particularly on the molecular mechanisms of transmittable or hereditary diseases, rather than on the five NCDs. Cyprus performs well in palliative care, which receives funding from several local charities and other non-profit organisations. Cyprus has the highest relative burden from diabetes in Europe, but the subject is largely neglected by researchers. Similarly, it suffers more from mental disorders than most of the rest of Europe, but the amount of research is relatively small. Respiratory conditions research is under-funded and under-researched too.ConclusionsThe biomedical research portfolio in Cyprus is adequate in volume, but not well fitted to its pattern of disease. The means whereby research can be used to improve healthcare in the country are also unsatisfactory, although the Ministry of Health is now developing a comprehensive plan which will include the development of clinical guidelines and proposals for the evaluation of how healthcare is delivered on the island.Electronic supplementary materialThe online version of this article (10.1186/s12961-018-0355-4) contains supplementary material, which is available to authorized users.

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“…There is already evidence that Cypriot patients, their carers and health care professionals are prepared to welcome new diabetes management models able to promote patient autonomy and self-management, and closer relationship between patient and health care professional. [13][14] This study aimed at understanding patients' preferences when choosing health care services for their diabetes care, and how they value SDM, as a process in which healthcare professionals and patients work together to select tests, treatments, management, or support packages, based on clinical evidence and patients' informed preferences. Results allowed to estimate the components of SDM that people value, their relative importance; but also the potential participation rates to SDM programmes.…”

Section: Introductionmentioning

confidence: 99%

Implementing shared-decision-making for diabetes care across country settings: What really matters to people?

Tinelli

Petrou²,

Samoutis

et al. 2017

Health Policy

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(Word number: 250)Diabetes is one of the leading causes of mortality, disability and expenditure worldwide. Growing evidence of improved outcomes (patient/professional satisfaction and some evidence on controlled weight, blood glucose and blood pressure) supports shareddecision-making (SDM) as an effective primary care intervention for diabetes. However, only a few countries have actually adopted it (e.g. UK). In other European countries there is awareness that patients play a crucial role in decision-making, and SDM policies could be considered as innovative strategies to promote the actual implementation of patient rights legislation and strengthen primary care (e.g. Cyprus). Objective of this research was to inform the development and testing of a tool to value patients' preferences for SDM model across different European settings: UK, where SDM is already in place at a national level, and we can draw from people direct experience; Cyprus, where people are new to it, although there could be room for future implementation. In doing so the study used a discrete-choice-experiment (DCE) survey. The DCE survey presents a series of choices involving alternative services on offer, described by their particular characteristics. It allows to: identify the characteristics of the health care service that respondents value; the relative values that they attach to these; and the trade-offs between them (e.g. how long patients are willing to wait to receive detailed and accurate information about their care). Data collection is under way and findings will be available for discussion at the meeting. They will inform the development of a larger European programme of research.

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A pilot quality improvement intervention in patients with diabetes and hypertension in primary care settings of Cyprus

Abstract: A pilot multifaceted quality improvement intervention programme for patients with diabetes and HTN implemented in primary care settings in Cyprus showed promising results. Future studies need to involve a broader number of practices and patient populations.

Cited by 18 publications

References 30 publications

Effectiveness of the EMPOWER-PAR Intervention on Primary Care Providers’ Adherence to Clinical Practice Guideline on the Management of Type 2 Diabetes Mellitus: A Pragmatic Cluster Randomised Controlled Trial

Effectiveness of the EMPOWER-PAR Intervention on Primary Care Providers’ Adherence to Clinical Practice Guideline on the Management of Type 2 Diabetes Mellitus: A Pragmatic Cluster Randomised Controlled Trial

The contribution of Cyprus to non-communicable diseases and biomedical research from 2002 to 2013: implications for evidence-based health policy

Implementing shared-decision-making for diabetes care across country settings: What really matters to people?

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