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Acomputer-based intervention system administered by primary care office staff could prove a highly effective and practical tool for type 2 diabetes patients and their physicians.
In a 12-month follow-up report of a study designed to improve the level and effectiveness of diabetes services, researchers found that doctors provided more recommended laboratory screenings and patient-centered activities with the help of a touchscreen assessment and care-planning system called the Diabetes Priority Program (DPP).1
The system also "does a good job" of bringing to the forefront significant behavioral issues such as healthy eating, increased physical activity, and smoking cessation, says lead investigator Russell Glasgow, PhD, of Kaiser Permanente Colorado.
Fifty-two family practice and internal medicine physicians from 30 clinics across Colorado participated in the study. They treated a total of 866 patients with type 2 diabetes (average age 63; 13% Latino).
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The doctors were randomized into intervention or control groups and evaluated on how they met the recommendations of the Diabetes Provider Recognition Program (DPRP), co-sponsored by the National Committee on Quality Assurance (NCQA) and the American Diabetes Association (ADA) (see FYI). Secondary outcomes were assessed using a diabetes quality-of-life scale, lipid and glycated hemoglobin (A1C) levels, and a depression scale.
The computer system was installed in the waiting rooms of participating practices. Before their regular diabetes-related office visits, patients were asked to recall when they had last received each of the 11 items in the DPRP measures. Seven measures relate to medical care and biological check-ups, such as measurement of blood pressure, cholesterol, and microalbumin, as well as foot and eye exams. The other four measures relate to behavioral and self-management counseling, such as setting self-management goals, receiving nutrition education or therapy, self-monitoring blood glucose, and measuring patient satisfaction.
The program also helped patients develop an action plan by selecting behavior-change goals based on their answers to questions about diet, physical activity, and smoking patterns. It guided patients in choosing specific activities to support their goals and identified solutions to overcome obstacles.
Completion of the program took about 15 minutes for patients, 1 minute for the physician, and 10 minutes for nurses or care managers trained in its use.
Physicians who used the program showed significant improvement on the medical/biological check-up measures, as well as on behavioral/self-management counseling. Despite a baseline that showed a high level of patient care (58–99% of patients already were receiving recommended services), patients in the intervention practices showed greater improvement in the NCQA/ADA performance measures than those in the control group.
However, patients treated by doctors in the intervention group did not show greater improvement in outcomes as measured by A1C and the quality-of-life scale. Glasgow attributes the disparity to the fact that many of the patients already had "good" A1C levels (mean 7.3%).
"It could be that [care quality improvement] is not going to
translate," he says. "However, from the standpoint of helping
patients prioritize their individual issues, it's definitely helpful."
Footnotes
The NCQA/ADA Diabetes Physician Recognition Program (DPRP) is a voluntary initiative that recognizes physicians who demonstrate high-quality care to patients with diabetes, based on the doctors' performance in meeting adult and pediatric care measures.
Learn more about the measures and other details of the program online at www.ncqa.org/dprp.
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| DOC News | Diabetes | Diabetes Care | Clinical Diabetes | Diabetes Spectrum |
