Combined task delegation, computerized decision support and feedback improve cardiovascular risk for type 2 diabetes patients. A cluster randomized trial in primary care
- Frits.G.W. Cleveringa, M.D. (f.g.w.cleveringa{at}umcutrecht.nl)1,
- Kees.J. Gorter, M.D., Ph.D.1,
- Maureen van den Donk, Ph.D.1 and
- Guy.E.H.M. Rutten, M.D., Ph.D.1
Abstract
Objective: The Diabetes Care Protocol combines task delegation (practice nurse), computerized decision support, and three-monthly feedback. We studied the effect of the Diabetes Care Protocol on HbA1c and cardiovascular risk factors in type 2 diabetes patients in primary care.
Research Design and Methods: In a cluster randomized trial, mean changes in cardiovascular risk factors between intervention and control group after one year were calculated by generalized linear models.
Results: Throughout the Netherlands 26 intervention practices included 1699 patients and 29 control practices 1692 patients. The difference in HbA1c change was not significant, total cholesterol, LDL-cholesterol, and blood pressure improved significantly more in the intervention group. The 10 year UKPDS coronary heart disease risk estimate improved 1.4% more in the intervention group.
Conclusions: Delegation of routine diabetes care to a practice nurse combined with computerized decision support and feedback did not improve HbA1c, but reduced cardiovascular risk in type 2 diabetes patients.
Footnotes
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- Received February 12, 2008.
- Accepted August 25, 2008.
- Copyright © American Diabetes Association
