Table 1—

Professional interventions versus usual care

ReferenceDesignIntervention i) intervention group c) control groupa) Number of providers b) Number of patients c) Number of practicesSettingFollow-up (months)Results
Conclusion
Patient outcomesProcess measures
Feder (21) 1995, U.K.RCTi) educational materials; local consensus processes; educational outreach visits; reminders c) no interventiona) 39 physicians supported by nurses b) 390 c) 24primary care physician office, capitation and item of service12NAglyc (+) bp (+) weight (+) microv (+)process +
Kinmonth (22) 1998, U.K.RCTi) educational materials/meetings; patient education (directed at ‘patient centered care’) c) educational materials/meetings; (focusing on use of guidelines and materials)a) 43 doctors supported by 64 nurses b) 250 c) 41primary care physician office; capitation and item of service12glyc (0) bp (0) chol (0) BMI (−) alb (0) well (+)NApatient 0 (well [+])
Litzelman (23) 1993, U.S.RCTi) educational materials; reminders; patient education; behavioral contacts with patients; reminders for patients c) no interventiona) ? (physicians supported by nurses [education]) b) 396 c) 1hospital-based academic primary care clinic; variable insurance arrangements*12microv (+)#microv (+)#patient + process +
Lobach (24) 1994 Lobach (25) 1997; U.S.RCTi) local consensus processes; audit and feedback; reminders c) no interventiona) 30 primary care clinicians b) 359 c) 1hospital-based academic primary care clinic; variable insurance arrangements6NAglyc (−)# chol (+)# ur prot (+)# microv (0)# compl (+)#process +
Mazze (26) 1994, U.S.RCTi) educational materials; educational meetings; local consensus processes; reminders c) no interventiona) 8 family practitioners b) 26 c) 1free-standing academic primary care clinic; variable insurance arrangements6glyc (+)visits (+/−) microv (+/−) educ (+/−) hlth surv (+/−)patient +/0nostatistical analyses but apositive trend) process +/−nostatistical analyses but apositive trend)
Mazzuca (27) 1990, U.S.RCTi1) educational meetings; reminders i2) i1; clinical materials i3) i2; patient education c) educational meetingsa) 98 internal medicine residents and faculty internists b) 2,791 c) 1hospital-based academic primary care clinic; variable insurance arrangements11NAglyc (+)process + (i2)
Palmer (28) 1990, U.S.RCTi) educational materials; local consensus procedures; audit and feedback c) no interventiona) ? b) 1,943 c) 8free-standing nonacademic primary care practice; variable insurance arrangements18NAcompl (0)process +
Pill (30) 1998, U.K.RCTi) educational meetings; educational outreach visits c) no interventiona) ? b) 190 c) 29primary care physician office; capitation and item of service18glyc (0)# bp (0)# BMI (0)# microv/macrov (0)#att pat (0)#patient 0 process 0
Ward (31) 1996, AustraliaRCTi) educational materials; educational outreach visits; audit and feedback by interview c) educational materials; postal feedbacka) 139 b) 386 c) ?primary care physician office; fee-for-service with small sessional and capitation payments8NAglyc (+)within bp (0)within chol (+)within weight (+)within alb (+)within microv (+)within compl (+)process
Carlson (32) 1991, SwedenRCTi) educational meetings; local consensus processes to identify problems and to create plans to improve diabetes care; educational outreach visits c) no interventiona) ? (physicians, nurses, nurse assistants managers, administrators, and laboratory technicians) b) 4,492 (measurements on professional practice) 566 (measurements on HbA1c) c) 34primary health care center; salary12glyc (0)#glyc (+)# microv (+)#patient 0 process +
Benjamin (20) 1999, U.S.CBAi) educational materials/meetings; local consensus processes; audit and feedback c) no interventiona) ? (physicians, residents, nurses, and nutritionist) b) 144 c) 2free-standing academic primary care clinic; variable insurance arrangements15glyc (+)#chol (+)# microv (+)#patient + process +within
Pieber (29) 1995, AustriaCBAi) educational materials/meetings; patient education c) no interventiona) 14 GPs b) 94 c) 14primary care physician office; fee-for-service6 glyc (+)# bp (0)# chol (0)# BMI (+)# microv (+)#withinNApatient +
  • *

    * In the U.S., most practices, whether hospital-based or not, care for patients under a variety of insurance arrangements: government (Medicare, Medicaid) or private (HMO or indemnity [fee-for-service]). ?, not reported; +, positive effect; 0, no effect; −, negative effect; +/−, effect unclear; NA, not applicable; #, possible unit of analysis error; within, differences are statistically tested within groups only, not between groups; alb, albumin; att pat, attendance patients; bp, blood pressure; comp, compliance care provider; CBA, controlled before-after study; creat, creatinine; glyc, glycemic control; HMO, health maintenance organization; hlth surv, health survey; hosp, hospitalizations; macrov, macrovascular complications; microv, microvascular complications; qual life, quality of life; RCT, randomized controlled trial.