The Diabetes Guidelines Implementation in Hospitals Study.

The clinical results of the study showed that, in both intervention groups, significant gains were found in HbA1c levels, but not in blood pressure levels. In the patient-centred group higher adherence rates were also found in examination of the feet and educational activities. Cost effectiveness analysis showed that cost effectiveness was found with the highest gains in the patient intervention group.

A patient centred or a porfessional directed intervention to improve adherence to diabetes guidelines in hospitals are more (cost) effective compared to usual care.

N/A

At hospitals in the professional-directed group (n=4), the health professionals received aggregated feedback on baseline data on their patient population. During an educational meeting for internists, DSNs and dieticians, the guidelines were discussed, promoted and distributed by a national opinion leader in diabetic care. Also desktop reminder cards of key guidelines were distributed, including a nomogram to easily calculate the BMI. Internists and DSNs preferred these reminder cards to locally adapted written protocols. After six months the internists received personal benchmarked feedback on their clinical performance.

At the hospitals in the patient centred group (n=4) intervention activities were addressed to the health care professionals and to the patients. As in the other intervention group feedback was given to the professionals on baseline data. During an educational meeting with a national opinion leader, guidelines as well as the diabetes passports were introduced. Barriers and facilitators to implement the diabetes passports in the clinic were discussed. Like in the other intervention group after six months personal feedback was given to the internists only, but this time on clinical performance as well as on the use of the diabetes passport. For the patients in the patient centred group, additional educational meetings were organised in collaboration with the local patient organisations. Furthermore 4,500 diabetes passports were made available at the four hospitals and waiting room posters, reminders for the patients to bring their passports and leaflets explaining how to use the passport were distributed. The passports were introduced and given to the patients by internists or DSNs during the clinic hours.