Sumit R. Majumdar|Lisa M. Guirguis|Ellen L. Toth|Richard Lewanczuk|T K Lee|Jeffrey Johnson
Controlled Trial of a Multifaceted Intervention for Improving Quality of Care for Rural Patients With Type 2 Diabetes
University of Alberta|Institute of Health Economics|Institute of Health Economics|Institute of Health Economics|University of Alberta|University of Alberta|University of Alberta|Grey Nuns Community Hospital|Institute of Health Economics|University of Alberta
objectivedespite good evidence clinical practice guidelines studies document treatment type 2 diabetes less optimal lack resources limited access may put patients rural communities particular risk suboptimal care research design methodswe conducted prospective beforeafter study concurrent controls assess effectiveness multidisciplinary diabetes outreach service intervention improving quality care rural patients type 2 diabetes intervention consisted six monthly visits traveling team specialist physicians nurses dieticians pharmacist core service specialisttorural primary care physician academic group detailing two comparable regions northern alberta randomly allocated control intervention data collected 6 months intervention representative volunteer sample primary outcome 10 improvement one following blood pressure total cholesterol hba1c resultsour analysis included 200 intervention 179 control subjects 14 subjects three primary outcome targets baseline intervention associated trend toward improvement primary outcome 6 months 44 intervention vs 37 control odds ratio 132 95 ci 087199 intervention associated significant improvement blood pressure 42 intervention vs 25 control p 0004 however small nonsignificant changes cholesterol hba1c intervention associated significant increase satisfaction diabetes care multivariate adjustment baseline differences intervention control subjects affect main results conclusionsa diabetes outreach service potential improve quality diabetes care rural patients future studies need involve longer timelines larger sample sizes