Shared care for diabetes: supporting communication between primary and secondary care

Branger, P. J.; Hooft, A van't; Wouden, Johannes C. van der; Moorman, Peter W.; Bemmel, Jan H. van

doi:10.1016/s1386-5056(98)00154-3

Cited by 58 publications

(65 citation statements)

References 19 publications

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“…Outcomes were assessed blindly or were objective (assessed by a standardized test) in 21 studies (22)(23)(24)(27)(28)(29)(30)33,34,36,40,41,47,51,52,56,58,60,61,63,66). In 14 studies, blinding of the outcome assessment was only partly adequate.…”

Section: Study Qualitymentioning

confidence: 99%

“…In 14 studies, blinding of the outcome assessment was only partly adequate. 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: Study Qualitymentioning

confidence: 99%

Section: Study Qualitymentioning

confidence: 99%

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

et al. 2001

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“…11,12 Prior surveys of physician IT use have been limited to single practice settings (often academic centers) or single technologies (such as e-mail communication). [13][14][15][16][17][18][19][20][21][22] To more fully address the issue of basic IT adoption by physicians actively engaged in patient care, we surveyed a national sample of primary care and specialist physicians to determine frequency of e-mail communication with patients or with other providers, online access to continuing medical education (CME) programs or professional journal web sites, and ''realtime'' computerized decision support (CDS) during patient care. These 5 technologies are technically simple to use and substantially less expense to adopt than EHRs.…”

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confidence: 99%

Prevalence of basic information technology use by U.S. physicians

Grant

Campbell²,

Gruen

et al. 2006

J Gen Intern Med

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BACKGROUND: Information technology (IT) has been advocated as an important means to improve the practice of clinical medicine. OBJECTIVES: To determine current prevalence of non‐electronic health record (EHR) IT use by a national sample of U.S. physicians, and to identify associated physician, practice, and patient panel characteristics. DESIGN, SETTING, AND PARTICIPANTS: Survey conducted in early 2004 of 1,662 U.S. physicians engaged in direct patient care selected from 3 primary care specialties (family practice, internal medicine, pediatrics) and 3 nonprimary care specialties (anesthesiology, general surgery, cardiology). MEASUREMENTS: Self‐reported frequency of e‐mail communication with patients or other clinicians, online access to continuing medical education or professional journals, and use of any computerized decision support (CDS) during clinical care. Survey results were weighted by specialty and linked via practice zip codes to measures of area income and urbanization. RESULTS: Response rate was 52.5%. Respondents spent 49 (±19) (mean [±standard deviation]) hours per week in direct patient care and graduated from medical school 23 (±11) years earlier. “Frequent” use was highest for CDS (40.8%) and online professional journal access (39.0%), and lowest for e‐mail communication with patients (3.4%). Ten percent of physicians never used any of the 5 IT tools. In separate logistic regression analyses predicting usage of each of the 5 IT tools, the strongest associations with IT use were primary care practice (adjusted odds ratios [aORs] ranging from 1.34 to 2.26) and academic practice setting (aORs 2.17 to 5.41). Years since medical school graduation (aOR 0.85 to 0.87 for every 5 years after graduation) and solo/2‐person practice setting (aORs 0.21 to 0.55) were negatively associated with IT use. Practice location and patient panel characteristics were not independently associated with IT use. CONCLUSIONS: In early 2004, the majority of physicians did not regularly use basic, inexpensive, and widely available IT tools in clinical practice. Efforts to increase the use of IT in medicine should focus on practice‐level barriers to adoption.

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“…EDI has been found to enhance the exchange and quality of information on diabetes-related parameters between GPs and the specialist services. 22 However, these technologies are still in their infancy.…”

Section: Discussionmentioning

confidence: 99%

Quality of GPs' referral letters to diabetes secondary care

Syed

Large

2003

Pract Diab Int

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Good quality referral information enables appropriate triage and the best use of scarce secondary care resources. We evaluated the quality of GPs' referral letters to our district general hospital diabetes centre to identify types of information that receive the highest and the least priority with the objective of developing constructive feedback.Eighty-one letters from 51 GPs, excluding requests for reassessment, emergency inpatient care or non-diabetic concerns, were evaluated on 24 parameters of varying clinical importance and categorised as 'low'(0.0-9.9), 'mid'(10.0-19.9) or 'high' (20.0-30.0) scoring (total 30.0 points).Total scores ranged from 4.5 to 30 (mean 13.3). Mean per cent scores (95% confidence intervals), for selected parameters were: home glucose monitoring 29. Overall, letters were lacking in information regarding surveillance, recognition and management of microangiopathy, blood pressure, body weight, home glucose monitoring and biochemistry. High-scoring letters reflected good insight into the care of people with diabetes.

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Shared care for diabetes: supporting communication between primary and secondary care

Cited by 58 publications

References 19 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

Prevalence of basic information technology use by U.S. physicians

Quality of GPs' referral letters to diabetes secondary care

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