Implementing practice guidelines for diabetes care using problem-based learning. A prospective controlled trial using firm systems.

Benjamin, Evan M.; Schneider, Marc S.; Hinchey, Kevin

doi:10.2337/diacare.22.10.1672

Cited by 68 publications

(50 citation statements)

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“…In 14 (20,21,23,28,29,31,39,44,(51)(52)(53)58,59,64) of these, the guidelines were locally developed, in 11 studies (22,24,26,27,32,35,36,47,55,57,60) they were based on national guidelines, and in 2 studies (46,54) the source of the guidelines was not specified.…”

Section: Discussionmentioning

confidence: 99%

“…In four of these studies (22,23,27,29), the professional intervention was combined with patient education. Postgraduate education of health care professionals combined with local consensus procedures and/or reminders and/or audit and feedback improved the provision of diabetes care in all studies (20,21,23,24,26,27,31,32) that did not demonstrate a good standard of care at baseline. The effect on patient outcomes was less clear because such outcomes were rarely assessed.…”

Section: Professional Interventions Versus Usual Carementioning

confidence: 99%

“…The effect on patient outcomes was less clear because such outcomes were rarely assessed. Improvements were described for glycemic control and serious foot lesions (20,23,26), although statistical significance was only achieved and reported in one study (23).…”

Section: Professional Interventions Versus Usual Carementioning

confidence: 99%

“…In 18 studies (21,(27)(28)(29)33,34,36,37,40,41,47,51,52,56,60,61,63,66), the outcomes were all reliably assessed (outcomes obtained from an automated system or a reported agreement between two raters Ͼ90% or Ն 0.8). Furthermore, 15 studies (20,22,26,32,35,39,44,46,50,53,54,57,59,62,64) included objective laboratory assessment of glycemic control.…”

Section: Study Qualitymentioning

confidence: 99%

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Interventions to Improve the Management of Diabetes in Primary Care, Outpatient, and Community Settings

et al. 2001

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OBJECTIVE -To review the effectiveness of interventions targeted at health care professionals and/or the structure of care in order to improve the management of diabetes in primary care, outpatient, and community settings. RESEARCH DESIGN AND METHODS-A systematic review of controlled trials evaluating the effectiveness of interventions targeted at health care professionals and aimed at improving the process of care or patient outcomes for patients with diabetes was performed. Standard search methods of the Cochrane Effective Practice and Organization of Care Group were used.RESULTS -A total of 41 studies met the inclusion criteria. The studies identified were heterogeneous in terms of interventions, participants, settings, and reported outcomes. In all studies, the interventions were multifaceted. The interventions were targeted at health care professionals only in 12 studies, at the organization of care only in 9 studies, and at both in 20 studies. Complex professional interventions improved the process of care, but the effect on patient outcomes remained less clear because such outcomes were rarely assessed. Organizational interventions that facilitated the structured and regular review of patients also showed a favorable effect on process measures. Complex interventions in which patient education was added and/or the role of a nurse was enhanced led to improvements in patient outcomes as well as the process of care.CONCLUSIONS -Multifaceted professional interventions and organizational interventions that facilitate structured and regular review of patients were effective in improving the process of care. The addition of patient education to these interventions and the enhancement of the role of nurses in diabetes care led to improvements in patient outcomes and the process of care. Diabetes Care 24:1821-1833, 2001D iabetes is a major and growing health care problem. Primarily because of the increasing prevalence of type 2 diabetes as well as the increase in cases of type 1 diabetes (1), it is expected that the number of people with diabetes will double by the year 2010 (2).Diabetes accounts for a huge burden of morbidity and mortality through micro-and macrovascular complications (3,4). However, it is now clear that strict control of blood glucose, blood pressure, and cholesterol can reduce the risk of diabetes-related complications (5-8). To achieve strict control, structured care is needed (9).Over the past 20 years, the responsibility for the care of people with diabetes has shifted away from hospitals to primary care (10,11). During this period, randomized trials have demonstrated that if regular review of patients is guaranteed, the standard of primary care can be as good or better than hospital outpatient care in the short term (9). Several guidelines and diabetes management programs have been developed nationally and locally to improve diabetes care in the community. However, empirical data suggest that compliance with diabetes clinical practice recommendations is inadequate in primary care (12)(13)(14...

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Section: Discussionmentioning

confidence: 99%

Section: Professional Interventions Versus Usual Carementioning

confidence: 99%

Section: Professional Interventions Versus Usual Carementioning

confidence: 99%

Section: Study Qualitymentioning

confidence: 99%

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Interventions to Improve the Management of Diabetes in Primary Care, Outpatient, and Community Settings

et al. 2001

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“…10 Traditional forms have been shown to be effective in changing practice when used with guidelines. 11 Traditional PBL involves group discussion, which has been thought to lead to clarification of learning needs and elaboration of learning. 12 Problems have been combined with email discussion groups, showing mixed results; 13,14 however, these courses are time consuming and require very considerable commitment on behalf of participants.…”

Section: Introductionmentioning

confidence: 99%

Web-based learning strategies in combination with published guidelines to change practice of primary care professionals

Robson

2009

Br J Gen Pract

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Published clinical guidelines need to be combined with effective educational interventions to produce change in practice. Problem-based learning (PBL) groups are effective; however, research studies have not looked at change in practice following PBL that is independent of group interaction. AimTo determine whether clinical guidelines combined with modified PBL e-learning modules, in which dialogue between learners is replaced by interaction with a computer, could increase knowledge, result in changes in practice, and be acceptable to participants as a mode of modifying practice. Design of studyQuantitative and qualitative methods. SettingWeb-based application. ResultsOnline PBL modules were studied by 45 primary care clinicians. Replacement of group functions by interaction with the computer was found to be an acceptable form of learning, and resulted in reported changes in practice among GPs choosing this method of study. This study shows that changes were independent of demonstrable knowledge gains. ConclusionOnline PBL modules could complement other arms of guideline-implementation strategies. More work is needed to determine which groups would benefit most.

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Health Care Use of Individuals With Diabetes in an Employer-Based Insurance Population

Laditka

Mastanduno²,

Laditka³

2001

Arch Intern Med

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Implementing practice guidelines for diabetes care using problem-based learning. A prospective controlled trial using firm systems.

Cited by 68 publications

References 0 publications

Interventions to Improve the Management of Diabetes in Primary Care, Outpatient, and Community Settings

Interventions to Improve the Management of Diabetes in Primary Care, Outpatient, and Community Settings

Web-based learning strategies in combination with published guidelines to change practice of primary care professionals

Health Care Use of Individuals With Diabetes in an Employer-Based Insurance Population

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