Improving Diabetes Care in Rural Areas: A Systematic Review and Meta-Analysis of Quality Improvement Interventions in OECD Countries

Abstract

Background and AimsDespite well documented disparities in health and healthcare in rural communities, evidence in relation to quality improvement (QI) interventions in those settings is still lacking. The main goals of this work were to assess the effectiveness of QI strategies designed to improve diabetes care in rural areas, and identify characteristics associated with greater success.MethodsWe conducted a systematic review and meta-analysis. Systematic electronic searches were conducted in MEDLINE, EMBASE, CINAHL, and 12 additional bibliographic sources. Experimental studies carried out in the OECD member countries assessing the effectiveness of QI interventions aiming to improve diabetes care in rural areas were included. The effect of the interventions and their impact on glycated hemoglobin was pooled using a random-effects meta-analysis.ResultsTwenty-six studies assessing the effectiveness of twenty QI interventions were included. Interventions targeted patients (45%), clinicians (5%), the health system (15%), or several targets (35%), and consisted of the implementation of one or multiple QI strategies. Most of the interventions produced a positive impact on processes of care or diabetes self-management, but a lower effect on health outcomes was observed. Interventions with multiple strategies and targeting the health system and/or clinicians were more likely to be effective. Six QI interventions were included in the meta-analysis (1,496 patients), which showed a significant reduction in overall glycated hemoglobin of 0.41 points from baseline in those patients receiving the interventions (95% CI -0.75% to -0.07%).ConclusionsThis work identified several characteristics associated with successful interventions to improve the quality of diabetes care in rural areas. Efforts to improve diabetes care in rural communities should focus on interventions with multiple strategies targeted at clinicians and/or the health system, rather than on traditional patient-oriented interventions.

The impact of a programme to improve quality of care for people with type 2 diabetes on hard to reach groups: The GEDAPS study

“…This situation may now be less relevant due to widespread internet use in most areas. Other studies have shown previously that quality improvement programmes in rural areas can result in improved patient outcomes [9][10][11]. However, these programmes were generally conducted only in rural areas, and the strength of GEDAPS is that it was conducted in both rural and urban areas.…”

“…Conversely, there was no focus on older age groups, and with the aging population of Catalonia and other countries it is important to understand the best way to care for older adults with diabetes. Research into this area is very limited, particularly regarding older adults, and while quality improvement programmes in rural areas have resulted in improved patient outcomes, these tended to be solely conducted in rural areas, rather than as part of a wider programme [9][10][11]; these novel analyses aim to address these gaps in knowledge.…”

Use of Quality Improvement Strategies Among Small to Medium-Size US Primary Care Practices

“…Primary care practices use quality improvement (QI) strategies, such as monitoring and assessing outcomes, having skilled QI teams, and using system redesigns to improve patient and population health outcomes, system performance, and clinician experience, and to reduce health care costs. [2][3][4][5][6] Implementing QI strategies can help practices deliver appropriate health services efficiently and improve health outcomes, [7][8][9][10] yet much of what we know about the use of QI strategies in medical care comes from surveys conducted mostly in hospitals and health systems.…”

Improvement noted after a multifaceted approach to diabetes mellitus management

“…Ricci-Cabello et al 8 proposed that, in order to improve diabetes care in resource-limited diabetes clinics, multiple intervention strategies need to be directed towards both the attending clinicians and patients. Involving a multidisciplinary team allows the primary clinician to spend more time on clinical assessment and assigns patient education to the team.…”