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

Fokkens AS, Wiegersma PA, van der Meer K, Reijneveld SA - BMC Health Serv Res (2011)

Bottom Line: These changes were found both at the healthcare professional and at the patient level.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.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Health Sciences, University Medical Center Groningen, University of Groningen, the Netherlands. a.s.fokkens@med.umcg.nl

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.

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Content of structured diabetes type 2 care
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Mentions: The Structured Care was an initiative of the local health insurance company, hospital, domiciliary care and general practitioners. The Structured Care contents were established in different phases (choice of intervention; identification of components, protocol and outcomes; effect study) [20] in close cooperation with the different healthcare providers. The goal of the SC was to establish comprehensive and efficient care for type 2 diabetes patients in a primary care setting [21]. The care was organized in accordance with the national clinical guidelines of the Dutch College of General Practitioners (Figure 1) [22,23] and enhanced with a number of organizational and educational components. Organizational aspects consisted of multidisciplinary cooperation, a clear task division and cooperation between the general practitioner (GP), the diabetes specialized nurse (DSN), the practice nurse and the dietician (Figure 2). The general practitioner remained responsible for the diabetes care in the entire practice population. As part of the intervention the following patients were referred to a dietician or a diabetes specialized nurse; all patients on insulin with a dosage adjusted longer than 12 months ago who had not visited a DSN in the meantime; all patients who had not visited a DSN or dietician for three years and over; patients with poorly controlled DM; all patients for whom either the GP or the PN or the patient judged a contact to be necessary.


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

Fokkens AS, Wiegersma PA, van der Meer K, Reijneveld SA - BMC Health Serv Res (2011)

Content of structured diabetes type 2 care
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3116472&req=5

Figure 2: Content of structured diabetes type 2 care
Mentions: The Structured Care was an initiative of the local health insurance company, hospital, domiciliary care and general practitioners. The Structured Care contents were established in different phases (choice of intervention; identification of components, protocol and outcomes; effect study) [20] in close cooperation with the different healthcare providers. The goal of the SC was to establish comprehensive and efficient care for type 2 diabetes patients in a primary care setting [21]. The care was organized in accordance with the national clinical guidelines of the Dutch College of General Practitioners (Figure 1) [22,23] and enhanced with a number of organizational and educational components. Organizational aspects consisted of multidisciplinary cooperation, a clear task division and cooperation between the general practitioner (GP), the diabetes specialized nurse (DSN), the practice nurse and the dietician (Figure 2). The general practitioner remained responsible for the diabetes care in the entire practice population. As part of the intervention the following patients were referred to a dietician or a diabetes specialized nurse; all patients on insulin with a dosage adjusted longer than 12 months ago who had not visited a DSN in the meantime; all patients who had not visited a DSN or dietician for three years and over; patients with poorly controlled DM; all patients for whom either the GP or the PN or the patient judged a contact to be necessary.

Bottom Line: These changes were found both at the healthcare professional and at the patient level.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.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Health Sciences, University Medical Center Groningen, University of Groningen, the Netherlands. a.s.fokkens@med.umcg.nl

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.

Show MeSH
Related in: MedlinePlus