Effect of a multicomponent intervention on achievement and improvements in quality‐of‐care indices among people with Type 2 diabetes in South Asia: the CARRS trial

Abstract

Aims To evaluate whether and what combinations of diabetes quality metrics were achieved in a multicentre trial in South Asia evaluating a multicomponent quality improvement intervention that included non-physician care coordinators to promote adherence and clinical decision-support software to enhance physician practices, in comparision with usual care. Methods Using data from the Centre for Cardiometabolic Risk Reduction in South Asia (CARRS) trial, we evaluated the proportions of trial participants achieving specific and combinations of five diabetes care targets (HbA 1c <53 mmol/ mol [7%], blood pressure <130/80 mmHg, LDL cholesterol <2.6 mmol/L, non-smoking status, and aspirin use). Additionally, we examined the proportions of participants achieving the following risk factor improvements from baseline: ≥11-mmol/mol (1%) reduction in HbA 1c , ≥10-mmHg reduction in systolic blood pressure, and/or ≥0.26-mmol/ l reduction in LDL cholesterol. Results Baseline characteristics were similar in the intervention and usual care arms. Overall, 12.3%, 29.4%, 36.5%, 19.5% and 2.2% of participants in the intervention group and 16.2%, 38.3%, 31.6%, 11.3% and 0.8% of participants in the usual care group achieved any one, two, three, four or five targets, respectively. We noted sizeable improvements in HbA 1c , blood pressure and cholesterol, and found that participants in the intervention group were twice as likely to achieve improvements in all three indices at 12 months that were sustained over 28 months of the study [relative risk 2.1 (95% CI 1.5,2.8) and 1.8 (95% CI 1.5,2.3), respectively]. Conclusions The intervention was associated with significantly higher achievement of and greater improvements in composite diabetes quality care goals. However, among these higher-risk participants, very small proportions achieved the complete group of targets, which suggests that achievement of multiple quality-of-care goals is challenging and that other methods may be needed in closing care gaps.

Know-do gaps for cardiovascular disease care in Cambodia: Evidence on clinician knowledge and delivery of evidence-based prevention actions

“…Therefore, clinicians who know and even intend on providing CVD care may face effort barriers and thus opt for the forms of care that they are most accustomed to providing. In such circumstances, providing clinical support tools and checklists that ease the attention and effort needed for clinicians to provide new forms of care may help to improve clinician CVD care behavior [27]. Clinicians may also simply lack the equipment (glucometers) needed to correctly conduct CVD risk assessments.…”