Improvements in Patient-Reported Outcomes Associated With an Intervention to Enhance Quality of Care for Rural Patients With Type 2 Diabetes
Results of a controlled trial
- Sheri L. Maddigan, MSC12,
- Sumit R. Majumdar, MD, MPH, FRCPC23,
- Lisa M. Guirguis, MSC2,
- Richard Z. Lewanczuk, MD, PHD, FRCPC4,
- T. K. Lee, MD, FRCPC356,
- Ellen L. Toth, MD, FRCPC24 and
- Jeffrey A. Johnson, PHD12
- 1Public Health Sciences, University of Alberta, Edmonton, Alberta, Canada
- 2Institute of Health Economics, Edmonton, Alberta, Canada
- 3Division of General Internal Medicine, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
- 4Division of Endocrinology and Metabolism, University of Alberta, Edmonton, Alberta, Canada
- 5Division of Pulmonary Medicine, University of Alberta, Edmonton, Alberta, Canada
- 6Department of Medicine, Grey Nuns Hospital, Edmonton, Alberta, Canada
- Address correspondence and reprint requests to Jeffrey A. Johnson, PhD, Institute of Health Economics, #1200 10405 Jasper Ave., Edmonton, Alberta, Canada T5J 3N4. E-mail: jeff.johnson{at}ualberta.ca
Abstract
OBJECTIVE—The aim of this study was to examine patient-reported outcomes in a controlled trial of a multifaceted provider-level intervention to improve quality of care for rural patients with type 2 diabetes.
RESEARCH DESIGN AND METHODS—We conducted a before/after intervention study with concurrent controls in two rural regions in Alberta, Canada. The intervention consisted of six monthly visits by a multidisciplinary health care team and was primarily directed at primary care providers. Clinical and patient-reported outcomes were assessed after 6 months. Patient-reported outcomes included changes in health-related quality of life (Health Utilities Index Mark 3 [HUI3]), satisfaction with care, lifestyle (Diabetes Lifestyle Form), and adherence to self-care activities. Analysis of covariance was used to assess differences over time between the control and intervention regions.
RESULTS—A total of 200 intervention and 172 control subjects were included in this analysis. After adjusting for important clinical and demographic differences, a statistically significant and clinically important improvement in the overall HUI3 score was seen at the 6-month follow-up in the intervention region (0.06 [95% CI 0.02–0.10]) compared with the control region (0.01 [−0.04 to 0.04]) (P = 0.03 for the difference between groups). Satisfaction with general medical care (P < 0.001 between groups) and diabetes care (P < 0.001 between groups) increased among patients in the intervention region compared with the control region. Self-efficacy, attitudes, and beliefs about diabetes control all increased in the intervention region when compared with the control region, but adherence to self-care activities did not.
CONCLUSIONS—A provider-level intervention directed at improving quality of clinical care for patients with type 2 diabetes also had a favorable impact on overall health-related quality of life, satisfaction with care, and other humanistic outcomes.
- CDA-TDRP, Canadian Diabetes Association Traveling Diabetes Resource Program
- DLF, Diabetes Lifestyle Form
- HRQL, health-related quality of life
- HUI3, Health Utilities Index Mark 3
Footnotes
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T.K.L. has received honoraria from AstraZeneca for speaking engagements.
A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.
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- Accepted February 25, 2004.
- Received January 6, 2004.
- DIABETES CARE
