Richard H. Glazier|Jana Bajcar|Natalie Kennie|K.H. Willson
A Systematic Review of Interventions to Improve Diabetes Care in Socially Disadvantaged Populations
St. Michael's Hospital|University of Toronto|St. Michael's Hospital|University of Toronto|St. Michael's Hospital|University of Toronto|University of Toronto
objectiveto identify synthesize evidence effectiveness patient provider health system interventions improve diabetes care among socially disadvantaged populations research design methodsstudies included targeted interventions toward socially disadvantaged adults type 1 type 2 diabetes conducted industrialized countries measured outcomes selfmanagement provider management clinical outcomes randomized controlled trials controlled trials beforeandafter studies contemporaneous control group seven databases searched articles published language january 1986 december 2004 twentysix intervention features identified analyzed terms association successful unsuccessful interventions resultseleven 17 studies met inclusion criteria positive results features appeared consistent positive effects included cultural tailoring intervention community educators lay people leading intervention oneonone interventions individualized assessment reassessment incorporating treatment algorithms focusing behaviorrelated tasks providing feedback highintensity interventions ampgt10 contact times delivered long duration 6 months interventions consistently associated largest negative outcomes included used mainly didactic teaching focused diabetes knowledge conclusionsthis systematic review provides evidence effectiveness interventions improve diabetes care among socially disadvantaged populations identifies key intervention features may predict success types interventions would require additional resources needs assessment leader training community family outreach followup