Improving quality of care for persons with diabetes: an overview of systematic reviews - what does the evidence tell us?

Abstract

BackgroundEnsuring high quality care for persons with diabetes remains a challenge for healthcare systems globally with consistent evidence of suboptimal care and outcomes. There is increasing interest in quality improvement strategies to improve diabetes management as reflected by a growing number of systematic reviews. These reviews are of varying quality and dispersed across many sources. In this paper, we present an overview of systematic reviews evaluating the impact of interventions to improve the quality of diabetes care.MethodsWe searched for systematic reviews evaluating the effectiveness of any intervention intended to improve intermediate patient outcomes and process of care measures for patients with any type of diabetes. Two reviewers independently screened search results, appraised each systematic review using AMSTAR and extracted data from high quality reviews (AMSTAR score ≥ 5). Within reviews, we used vote counting by direction of effect to report the number of studies favouring an intervention for each outcome. We produced summaries of results for each intervention category.ResultsWe identified 125 reviews of varying methodological quality and summarised key findings from 50 high quality reviews. We categorised reviews by quality improvement intervention. Eight reviews were broad based (involving a variety of strategies). Other reviews considered: patient education and support (n = 21), telemedicine (n = 10), provider role changes (n = 7), and organisational changes (n = 4). Reviews reported intermediate patient outcomes (e.g. glycaemic control) (n = 49) and process of care outcomes (n = 9). There was evidence of considerable overlap of included studies between reviews.ConclusionsThere is consistent evidence from high quality systematic reviews that patient education and support, provider role changes, and telemedicine are associated with improvements in glycaemic and vascular risk factor control in patients. There is less evidence about the impact of quality improvement interventions on other key process measures such as screening patients for diabetic complications. This paper provides decision makers with a comprehensive overview of evidence from high quality systematic reviews about the effects of quality improvement interventions on improving diabetes care.

Epidemiological characteristics and methodological quality of meta-analyses on diabetes mellitus treatment: a systematic review

“…Our results suggested that methodological quality of the MAs included in this study were generally poor, with less than 50% of them satisfying seven out of 11 AMSTAR items. This is consistent with the result of a study that focused on strategies for improving quality of care among DM patients (10). That study only found that 60% of the 125 included SRs only met four of the 11 AMSTAR methodological criteria.…”

Identification of Risk Factors for Diabetes Type 2 and Components of Pharmacists’ Interventions in Community Pharmacy Setting: A Serbian Pilot Study.

“…Also, there was some evidence that tailoring interventions to specific cultural or age groups might be of benefit to the effectiveness of the treatment strategy. 38 Considering this, pharmacists in our study provided appropriate, individually targeted interventions, provided good knowledge and clinical skills.…”

“…This is quite a different approach to our opportunistic screening approach in diabetes prevention with post-screening cognitive service intervention (that is with complex intervention). In systematic reviews of diabetes quality improvement interventions 38 there is consistent evidence to indicate that a number of interventions, for example, patient education and support, telemedicine, and provider role changes, appeared to improve diabetes quality of care. Also, there was some evidence that tailoring interventions to specific cultural or age groups might be of benefit to the effectiveness of the treatment strategy.…”

Mobile App for Improved Self-Management of Type 2 Diabetes: Multicenter Pragmatic Randomized Controlled Trial (Preprint)

“…The increasing prevalence of T2DM will put pressure on health systems to appropriately manage these patients to avoid diabetic complications. Optimizing self-management of glycemic control and other risk factors in conjunction with pharmacologic therapy may be an efficient way to improve patient outcomes [2][3][4][5]. While selfmanagement has been traditionally in person educational programs that are resource intensive, advances in mobile technology now provide the opportunity to deliver effective self-management support to patients in a convenient and potentially cost effective manner [6][7][8][9][10][11].…”