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EFFECT OF A NATIONWIDE PROGRAM OF EDUCATIONAL OUTREACH VISITS TO IMPROVE THE PROCESSES OF CARE FOR PATIENTS WITH TYPE 2 DIABETES

Published online by Cambridge University Press:  21 April 2004

Philippe Ricordeau ,
Pierre Durieux ,
Alain Weill ,
Gilles Chatellier ,
Nathalie Vallier ,
Alvine Bissery ,
Pierre Fender  and
Hubert Allemand
Philippe Ricordeau
Affiliation:
Caisse nationale d'assurance maladie des travailleurs salariés
Pierre Durieux
Affiliation:
Hôpital Européen Georges Pompidou
Alain Weill
Affiliation:
Caisse nationale d'assurance maladie des travailleurs salariés
Gilles Chatellier
Affiliation:
Hôpital Européen Georges Pompidou
Nathalie Vallier
Affiliation:
Caisse nationale d'assurance maladie des travailleurs salariés
Alvine Bissery
Affiliation:
Hôpital Européen Georges Pompidou
Pierre Fender
Affiliation:
Caisse nationale d'assurance maladie des travailleurs salariés
Hubert Allemand
Affiliation:
Caisse nationale d'assurance maladie des travailleurs salariés
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Abstract

Objectives: To improve processes of ambulatory care for patients with type 2 diabetes in a nationwide program.

Methods: Interrupted time-series analysis with audits of practice. To implement selected recommendations of national guidelines, educational outreach visits (office visits or phone discussions) were offered to all French physicians who diagnosed one case of type 2 diabetes during a six-month intervention period. Outcome measures were the number of HBA1c measurements recorded monthly in the medical insurance computer database and the proportion of diabetic patients for whom one test had been reimbursed during the previous six months (HBA1c, fasting blood glucose) or previous twelve months (serum cholesterol, serum creatinine, urine microalbumin, electrocardiogram, ophthalmologic examination).

Results: A total of 15,522 office visits and 9,062 telephone discussions were performed among 22,940 physicians. The increase in the monthly proportion of the number of HBA1c tests to the total number of laboratory tests was higher during the intervention period than during the preintervention (p value<.0001) and postintervention periods (p value<.001). Between the first audit (n=651,574) and the third audit (n=911,871), HBA1c measurements increased from 41.2% to 60.5% and blood glucose measurements performed alone decreased from 38.8% to 18.7%. Urine microalbumin measurements increased from 10.6% before to 15.3% after intervention. Only a slight increase was observed for other tests.

Conclusions: Physician to physician outreach visits can be an effective way to improve the processes of care for diabetes and to routinize nationwide use of practice guidelines.

Keywords

Educational outreach visitsDiabetesPractice guidelinesIntervention studiesEvidence based health policy
Type
RESEARCH NOTES
Information
International Journal of Technology Assessment in Health Care , Volume 19 , Issue 4 , December 2003 , pp. 705 - 710
Copyright
© 2004 Cambridge University Press

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References

1999 Agence française de sécurité sanitaire des produits de santé. Traitement médicamenteux du diabète de type 2. Paris: AFSSAPS; Available at: http://afssaps.sante.fr. Accessed October 1, 2003.
2000 Agence nationale pour le développement de l'évaluation médicale. Strategy for management of type 2 diabetes excluding management of complications. Paris: ANAES; Available at: www.anaes.fr. Accessed October 1, 2003.
Bero LA, Grilli R, Grimshaw JM et al. 1998 Closing the gap between research and practice: An overview of systemic reviews of interventions to promote the implementation of research findings. BMJ. 317: 465- 468.Google Scholar
Garber AM. 2001 Evidence-based coverage policy. Health Aff (Millwood). 20: 62- 82.Google Scholar
Iezzoni LI. 1997 Assessing quality using administrative data. Ann Intern Med. 127: 666- 674.Google Scholar
Lohr KN, Eleazer K, Mauskopf J. 1998 Health policy issues and applications for evidence-based medicine and clinical practice guidelines. Health Policy. 46: 1- 19.Google Scholar
Palmer RH. 1997 Process-based measures of quality: The need for detailed clinical data in large health care databases. Ann Intern Med. 127: 733- 738.Google Scholar
Renders CM, Valk GD, Griffin S et al. 2001 Interventions to improve the management of diabetes mellitus in primary care, outpatient and community settings (Cochrane review). In: The Cochrane Library, Issue 2, Oxford: Update Software.
Ricordeau P, Weill A, Vallier N et al. 2000 L'épidémiologie du diabète en France métropolitaine. Diabetes Metab. 26(Suppl 6): 11- 24.Google Scholar
Thomson O'Brien MA, Oxman AD et al. 2000 Educational outreach visits to improve health professional practice and health care outcome. (Cochrane Review). In: The Cochrane Library, Issue 1, Oxford: Update Software.