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Published in: BMC Health Services Research 1/2011

Open Access 01-12-2011 | Research article

Structured diabetes care leads to differences in organization of care in general practices: the healthcare professional and patient perspective

Authors: Andrea S Fokkens, P Auke Wiegersma, Klaas van der Meer, Sijmen A Reijneveld

Published in: BMC Health Services Research | Issue 1/2011

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Abstract

Background

Care for patients with chronic diseases is challenging and requires multifaceted interventions to appropriately coordinate the entire treatment process. The effect of such interventions on clinical outcomes has been assessed, but evidence of the effect on organization of care is scarce.
The aim is to assess the effect of structured diabetes care on organization of care from the perspective of patients and healthcare professionals in routine practice, and to ascertain whether this effect persists

Methods

In a quasi-experimental study the effect of structured care (SC) was compared with care-as-usual (CAU). Questionnaires were sent to healthcare professionals (SC n = 31; CAU n = 11) and to patients (SC n = 301; CAU n = 102). A follow-up questionnaire was sent after formal support of the intervention ended (2007).

Results

SC does have an effect on the organization of care. More cooperation between healthcare professionals, less referrals to secondary care and more education were reported in the SC group as compared to the CAU group. These changes were found both at the healthcare professional and at the patient level. Organizational changes remained after formal support for the intervention support had ended.

Conclusion

According to patients and healthcare professionals, structured care does have a positive effect on the organization of care. The use of these two sources of information is important, not only to assess the value of changes in care for the patient and the healthcare provider but also to ascertain the validity of the results found.
Appendix
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Literature
1.
go back to reference Bodenheimer T, Wagner EH, Grumbach K: Improving primary care for patients with chronic illness. JAMA. 2002, 288 (14): 1775-9. 10.1001/jama.288.14.1775.CrossRefPubMed Bodenheimer T, Wagner EH, Grumbach K: Improving primary care for patients with chronic illness. JAMA. 2002, 288 (14): 1775-9. 10.1001/jama.288.14.1775.CrossRefPubMed
2.
go back to reference Norris SL: The effectiveness of disease and case management for people with diabetes. A systematic review. American journal of preventive medicine. 2002, 15-38. Norris SL: The effectiveness of disease and case management for people with diabetes. A systematic review. American journal of preventive medicine. 2002, 15-38.
3.
go back to reference Renders CM, Valk GD, Griffin SJ, Wagner EH, Eijk V, Assendelft WJ: Interventions to improve the management of diabetes in primary care, outpatient, and community settings: A systematic review. Diabetes Care. 2001, 10: 1821-33.CrossRef Renders CM, Valk GD, Griffin SJ, Wagner EH, Eijk V, Assendelft WJ: Interventions to improve the management of diabetes in primary care, outpatient, and community settings: A systematic review. Diabetes Care. 2001, 10: 1821-33.CrossRef
4.
go back to reference Maislos M, Weisman D: Multidisciplinary approach to patients with poorly controlled type 2 diabetes mellitus: A prospective, randomized study. Acta Diabetol. 2004, 06: 44-8. Maislos M, Weisman D: Multidisciplinary approach to patients with poorly controlled type 2 diabetes mellitus: A prospective, randomized study. Acta Diabetol. 2004, 06: 44-8.
5.
go back to reference Cleveringa FG, Gorter KJ, van den DM, Rutten GE: Combined task delegation, computerized decision support and feedback improve cardiovascular risk for type 2 diabetes patients. A cluster randomized trial in primary care. Diabetes Care. 2008 Cleveringa FG, Gorter KJ, van den DM, Rutten GE: Combined task delegation, computerized decision support and feedback improve cardiovascular risk for type 2 diabetes patients. A cluster randomized trial in primary care. Diabetes Care. 2008
6.
go back to reference Gabbay RA: Nurse case management improves blood pressure, emotional distress and diabetes complication screening. Diabetes research and clinical practice. 2006, 28-35. Gabbay RA: Nurse case management improves blood pressure, emotional distress and diabetes complication screening. Diabetes research and clinical practice. 2006, 28-35.
7.
go back to reference Peterson KA, Radosevich DM, O'Connor PJ, Nyman JA, Prineas RJ, Smith SA, Arneson TJ, Corbett VA, Weinhandl JC, Lange CJ, Hannan PJ: Improving diabetes in practice: Findings from the TRANSLATE trial. Diabetes Care. 2008 Peterson KA, Radosevich DM, O'Connor PJ, Nyman JA, Prineas RJ, Smith SA, Arneson TJ, Corbett VA, Weinhandl JC, Lange CJ, Hannan PJ: Improving diabetes in practice: Findings from the TRANSLATE trial. Diabetes Care. 2008
8.
go back to reference Piatt GA, Orchard TJ, Emerson S, Simmons D, Songer TJ, Brooks MM, Korytkowski M, Siminerio LM, Ahmad U, Zgibor JC: Translating the chronic care model into the community: Results from a randomized controlled trial of a multifaceted diabetes care intervention. Diabetes Care. 2006, 04: 811-7.CrossRef Piatt GA, Orchard TJ, Emerson S, Simmons D, Songer TJ, Brooks MM, Korytkowski M, Siminerio LM, Ahmad U, Zgibor JC: Translating the chronic care model into the community: Results from a randomized controlled trial of a multifaceted diabetes care intervention. Diabetes Care. 2006, 04: 811-7.CrossRef
9.
go back to reference Mullen BA, Kelley PA: Diabetes nurse case management: An effective tool. Journal of the American Academy of Nurse Practitioners. 2006, 22-30. Mullen BA, Kelley PA: Diabetes nurse case management: An effective tool. Journal of the American Academy of Nurse Practitioners. 2006, 22-30.
10.
go back to reference Olivarius ND, Beck-Nielsen H, Andreasen AH, Horder M, Pedersen PA: Randomised controlled trial of structured personal care of type 2 diabetes mellitus. Br Med J. 2001, 10 (27): 970-5.CrossRef Olivarius ND, Beck-Nielsen H, Andreasen AH, Horder M, Pedersen PA: Randomised controlled trial of structured personal care of type 2 diabetes mellitus. Br Med J. 2001, 10 (27): 970-5.CrossRef
11.
go back to reference Ilag LL, Martin CL, Tabaei BP, Isaman DJ, Burke R, Greene DA, Herman WH: Improving diabetes processes of care in managed care. Diabetes Care. 2003, 10: 2722-7.CrossRef Ilag LL, Martin CL, Tabaei BP, Isaman DJ, Burke R, Greene DA, Herman WH: Improving diabetes processes of care in managed care. Diabetes Care. 2003, 10: 2722-7.CrossRef
12.
go back to reference Renders CM, Valk GD, Franse LV, Schellevis FG, van Eijk JT, van der Wal G: Long-term effectiveness of a quality improvement program for patients with type 2 diabetes in general practice. Diabetes Care. 2001, 08: 1365-70.CrossRef Renders CM, Valk GD, Franse LV, Schellevis FG, van Eijk JT, van der Wal G: Long-term effectiveness of a quality improvement program for patients with type 2 diabetes in general practice. Diabetes Care. 2001, 08: 1365-70.CrossRef
13.
go back to reference Ubink-Veltmaat LJ, Bilo HJ, Groenier KH, Rischen RO, Meyboom-de Jong B: Shared care with task delegation to nurses for type 2 diabetes: Prospective observational study. Neth J Med. 2005, 03: 103-10. Ubink-Veltmaat LJ, Bilo HJ, Groenier KH, Rischen RO, Meyboom-de Jong B: Shared care with task delegation to nurses for type 2 diabetes: Prospective observational study. Neth J Med. 2005, 03: 103-10.
14.
go back to reference Keating NL, Landrum MB, Landon BE, Ayanian JZ, Borbas C, Guadagnoli E: Measuring the quality of diabetes care using administrative data: Is there bias?. Health Serv Res. 2003, 1529-45. Keating NL, Landrum MB, Landon BE, Ayanian JZ, Borbas C, Guadagnoli E: Measuring the quality of diabetes care using administrative data: Is there bias?. Health Serv Res. 2003, 1529-45.
15.
go back to reference Wagner EH, Sandhu N, Newton KM, McCulloch DK, Ramsey SD, Grothaus LC: Effect of improved glycemic control on health care costs and utilization. JAMA. 2001, 01 (10): 182-9.CrossRef Wagner EH, Sandhu N, Newton KM, McCulloch DK, Ramsey SD, Grothaus LC: Effect of improved glycemic control on health care costs and utilization. JAMA. 2001, 01 (10): 182-9.CrossRef
16.
go back to reference Moncher FJ, Prinz RJ: Treatment fidelity in outcomes studies. Clinical psychology review. 1991, 247. Moncher FJ, Prinz RJ: Treatment fidelity in outcomes studies. Clinical psychology review. 1991, 247.
17.
go back to reference Keller C, Fleury J, Sidani S, Ainsworth B: Fidelity to theory in PA intervention research. West J Nurs Res. 2009, 289-311. Keller C, Fleury J, Sidani S, Ainsworth B: Fidelity to theory in PA intervention research. West J Nurs Res. 2009, 289-311.
18.
go back to reference Dumas JE, Lynch AM, Laughlin JE, Phillips Smith E, Prinz RJ: Promoting intervention fidelity. conceptual issues, methods, and preliminary results from the EARLY ALLIANCE prevention trial. Am J Prev Med. 2001, 38-47. 1 Suppl Dumas JE, Lynch AM, Laughlin JE, Phillips Smith E, Prinz RJ: Promoting intervention fidelity. conceptual issues, methods, and preliminary results from the EARLY ALLIANCE prevention trial. Am J Prev Med. 2001, 38-47. 1 Suppl
19.
go back to reference Finkelstein JA, Lozano P, Streiff KA, Arduino KE, Sisk CA, Wagner EH, Weiss KB, Inui TS: Clinical effectiveness research in managed-care systems: Lessons from the pediatric asthma care PORT. patient outcomes research team. Health Serv Res. 2002, 775-89. Finkelstein JA, Lozano P, Streiff KA, Arduino KE, Sisk CA, Wagner EH, Weiss KB, Inui TS: Clinical effectiveness research in managed-care systems: Lessons from the pediatric asthma care PORT. patient outcomes research team. Health Serv Res. 2002, 775-89.
20.
go back to reference Campbell M, Fitzpatrick R, Haines A, Kinmonth AL, Sandercock P, Spiegelhalter D, Tyrer P: Framework for design and evaluation of complex interventions to improve health. BMJ. 2000, 16: 694-6.CrossRef Campbell M, Fitzpatrick R, Haines A, Kinmonth AL, Sandercock P, Spiegelhalter D, Tyrer P: Framework for design and evaluation of complex interventions to improve health. BMJ. 2000, 16: 694-6.CrossRef
21.
go back to reference Fokkens AS, Wiegersma PA, Beltman FW, Reijneveld SA: Structured primary care for type 2 diabetes has positive effects on clinical outcomes. J Eval Clin Pract. 2010 Fokkens AS, Wiegersma PA, Beltman FW, Reijneveld SA: Structured primary care for type 2 diabetes has positive effects on clinical outcomes. J Eval Clin Pract. 2010
22.
go back to reference Bouma M, Rutten GE, de Grauw WJ, Wiersma T, Goudswaard AN: [Summary of the practice guideline 'diabetes mellitus type 2' (second revision) from the dutch college of general practitioners]. Ned Tijdschr Geneeskd. 2006, 2251-6. Bouma M, Rutten GE, de Grauw WJ, Wiersma T, Goudswaard AN: [Summary of the practice guideline 'diabetes mellitus type 2' (second revision) from the dutch college of general practitioners]. Ned Tijdschr Geneeskd. 2006, 2251-6.
23.
go back to reference Wiersma TJ, Heine RJ, Rutten GE: [Summary of the practice guideline 'diabetes mellitus type 2' (first revision) of the dutch college of general practitioners]. Ned Tijdschr Geneeskd. 1999, 143 (33): 1688-91.PubMed Wiersma TJ, Heine RJ, Rutten GE: [Summary of the practice guideline 'diabetes mellitus type 2' (first revision) of the dutch college of general practitioners]. Ned Tijdschr Geneeskd. 1999, 143 (33): 1688-91.PubMed
24.
go back to reference Piwernetz K: DIABCARE quality network in europe--a model for quality management in chronic diseases. Int Clin Psychopharmacol. 2001, 16 (Suppl 3): S5-13.CrossRefPubMed Piwernetz K: DIABCARE quality network in europe--a model for quality management in chronic diseases. Int Clin Psychopharmacol. 2001, 16 (Suppl 3): S5-13.CrossRefPubMed
25.
go back to reference Fokkens AS, Wiegersma PA, Reijneveld SA: A structured registration program can be validly used for quality assessment in general practice. BMC Health Serv Res. 2009, 9: 241-10.1186/1472-6963-9-241.CrossRefPubMedPubMedCentral Fokkens AS, Wiegersma PA, Reijneveld SA: A structured registration program can be validly used for quality assessment in general practice. BMC Health Serv Res. 2009, 9: 241-10.1186/1472-6963-9-241.CrossRefPubMedPubMedCentral
26.
go back to reference Shortell SM, Marsteller JA, Lin M, Pearson ML, Wu SY, Mendel P, Cretin S, Rosen M: The role of perceived team effectiveness in improving chronic illness care. Med Care. 2004, 1040-8. Shortell SM, Marsteller JA, Lin M, Pearson ML, Wu SY, Mendel P, Cretin S, Rosen M: The role of perceived team effectiveness in improving chronic illness care. Med Care. 2004, 1040-8.
27.
go back to reference Nutting PA, Dickinson WP, Dickinson LM, Nelson CC, King DK, Crabtree BF, Glasgow RE: Use of chronic care model elements is associated with higher-quality care for diabetes. Ann Fam Med. 2007, 01: 14-20.CrossRef Nutting PA, Dickinson WP, Dickinson LM, Nelson CC, King DK, Crabtree BF, Glasgow RE: Use of chronic care model elements is associated with higher-quality care for diabetes. Ann Fam Med. 2007, 01: 14-20.CrossRef
28.
go back to reference Bosch M, Dijkstra R, Wensing M, van der Weijden T, Grol R: Organizational culture, team climate and diabetes care in small office-based practices. BMC Health Serv Res. 2008, 8: 180-10.1186/1472-6963-8-180.CrossRefPubMedPubMedCentral Bosch M, Dijkstra R, Wensing M, van der Weijden T, Grol R: Organizational culture, team climate and diabetes care in small office-based practices. BMC Health Serv Res. 2008, 8: 180-10.1186/1472-6963-8-180.CrossRefPubMedPubMedCentral
29.
go back to reference Powsner SM, Wyatt JC, Wright P: Opportunities for and challenges of computerisation. Lancet. 1998, 1617-22. Powsner SM, Wyatt JC, Wright P: Opportunities for and challenges of computerisation. Lancet. 1998, 1617-22.
30.
go back to reference Pill R: A randomized controlled trial of an intervention designed to improve the care given in general practice to type II diabetic patients: Patient outcomes and professional ability to change behaviour. Fam Pract. 1998, 229-35. Pill R: A randomized controlled trial of an intervention designed to improve the care given in general practice to type II diabetic patients: Patient outcomes and professional ability to change behaviour. Fam Pract. 1998, 229-35.
31.
go back to reference van Bruggen R, Gorter KJ, Stolk RP, Verhoeven RP, Rutten GE: Implementation of locally adapted guidelines on type 2 diabetes. Fam Pract. 2008, 12: 430-7.CrossRef van Bruggen R, Gorter KJ, Stolk RP, Verhoeven RP, Rutten GE: Implementation of locally adapted guidelines on type 2 diabetes. Fam Pract. 2008, 12: 430-7.CrossRef
32.
go back to reference Spigt M, Stefens C, Passage D, Van Amelsvoort L, Zwietering P: The relationship between primary health care organization and quality of diabetes care. Eur J Gen Pract. 2009, 15 (4): 212-8. 10.3109/13814780903390814.CrossRefPubMed Spigt M, Stefens C, Passage D, Van Amelsvoort L, Zwietering P: The relationship between primary health care organization and quality of diabetes care. Eur J Gen Pract. 2009, 15 (4): 212-8. 10.3109/13814780903390814.CrossRefPubMed
Metadata
Title
Structured diabetes care leads to differences in organization of care in general practices: the healthcare professional and patient perspective
Authors
Andrea S Fokkens
P Auke Wiegersma
Klaas van der Meer
Sijmen A Reijneveld
Publication date
01-12-2011
Publisher
BioMed Central
Published in
BMC Health Services Research / Issue 1/2011
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/1472-6963-11-113

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