A practical randomized trial to improve diabetes care
Open accessAbstract
Objective There is a well-documented gap between diabetes care guidelines and the services received by patients in almost all health care settings. This project reports initial results from a computer-assisted, patient-centered intervention to improve the level of recommended services received by patients from a wide variety of primary care providers.Design and settings Eight hundred eighty-six patients with type 2 diabetes under the care of 52 primary care physicians participated in the Diabetes Priority Program. Physicians were stratified and randomized to intervention or control conditions and evaluated on 2 primary outcomes: number of recommended laboratory screenings and recommended patient-centered care activities completed. Secondary outcomes were evaluated using the Problem Areas in Diabetes scale and the Patient Health Questionnaire (PHQ)-9 depression scale, and the RE-AIM framework was used to evaluate potential for dissemination.Results The program was well-implemented and significantly improved both number of recommended laboratory assays (3.4 vs 3.1; P <.001) and patient-centered aspects of diabetes care patients received (3.6 vs 3.2; P <.001) compared to those in randomized control practices. Activities that were increased most were foot exams (follow-up rates of 80% vs 52%; P <.003) and nutrition counseling (76% vs 52%; P <.001).Conclusions Patients are very willing to participate in a brief computer-assisted intervention that is effective in enhancing quality of diabetes care. Staff in primary care offices can consistently deliver an intervention of this nature, but most physicians were unwilling to participate in this translation research study.
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We judged sequence allocation and/or concealment to be adequate in six other studies, even though they were only partially described.
“We judged sequence allocation and/or concealment to be adequate in six other studies, even though they were only partially described (Alder 2007; Brown 2001; Glasgow 2004; Haskard 2008; Hobma 2006; Pill 1998).”
From Interventions for providers to promote a patient-centred approach in clinical consultations (2012) · cites this paper as Glasgow 2004
All five studies that measured consultation process outcomes reported at least one consultation process outcome in favour of the intervention.
“and all of these (Brown 2001; Glasgow 2004; Kinmonth 1998; Krones 2008; Loh 2007) reported at least one consultation process outcome in favour of the intervention.”
From Interventions for providers to promote a patient-centred approach in clinical consultations (2012) · cites this paper as Glasgow 2004
In Glasgow 2004, providers in the intervention group performed better in three of six condition-specific process measures.
“Similarly, providers in the intervention group in Glasgow 2004 completed more PCC activities and performed better in three of six condition‐specific process measures.”
From Interventions for providers to promote a patient-centred approach in clinical consultations (2012) · cites this paper as Glasgow 2004
In Glasgow 2004, providers in the intervention group completed more PCC activities.
“Similarly, providers in the intervention group in Glasgow 2004 completed more PCC activities and performed better in three of six condition‐specific process measures.”
From Interventions for providers to promote a patient-centred approach in clinical consultations (2012) · cites this paper as Glasgow 2004
Five of the six studies in intervention category 4 assessed between one and three health behaviour outcomes.
“Five of the six studies assessed between one and three outcomes in this category (Brown 2001; Glasgow 2004; Kinmonth 1998; Krones 2008; Loh 2007)”
From Interventions for providers to promote a patient-centred approach in clinical consultations (2012) · cites this paper as Glasgow 2004
The remaining studies (Glasgow 2004; Krones 2008; Loh 2007) did not find any benefit of intervention on health status.
“The remaining studies (Glasgow 2004; Krones 2008; Loh 2007) did not find any benefit of intervention on health status.”
From Interventions for providers to promote a patient-centred approach in clinical consultations (2012) · cites this paper as Glasgow 2004
Four of the six studies in intervention category 4 assessed satisfaction.
“Four of the six studies assessed this outcome (Glasgow 2004; Kinmonth 1998; Krones 2008; Loh 2007)”
From Interventions for providers to promote a patient-centred approach in clinical consultations (2012) · cites this paper as Glasgow 2004
In Glasgow 2004, there was no difference between intervention and control groups in depression after 6 months.
“For example, Glasgow 2004 found no difference between the intervention and control groups in either quality of life or depression after 6 months.”
From Interventions for providers to promote a patient-centred approach in clinical consultations (2012) · cites this paper as Glasgow 2004
In Glasgow 2004, there was no difference between intervention and control groups in quality of life after 6 months.
“For example, Glasgow 2004 found no difference between the intervention and control groups in either quality of life or depression after 6 months.”
From Interventions for providers to promote a patient-centred approach in clinical consultations (2012) · cites this paper as Glasgow 2004
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- Authors
- Glasgow, R. E., Nutting, P. A., King, D. K., Nelson, C. C., Cutter, G., Gaglio, B., Rahm, A. K., Whitesides, H., & Amthauer, H.
- Affiliations
- Kaiser Permanente (US)
- Center for Research Strategies (US)
- Cooper Institute (US)
- Corresponding author
- Glasgow, Russell E.
- ORCID
- Venue
- Journal of General Internal Medicine
- Published
- 2004-12
- Volume
- 19
- Issue
- 12
- Pages
- 1167-1174
- ISSN
- 0884-8734 (ISSN-L)
- 1525-1497
- PMC
- PMC1492587
- OpenAlex
- W2045207173
- Cited by
- 94
- References
- 29
- Citations by year
- 2026: 1 · 2025: 1 · 2023: 1 · 2022: 2 · 2021: 1 · 2020: 3 · 2019: 4 · 2018: 6 · 2017: 2 · 2016: 6 · 2015: 6 · 2014: 3 · 2013: 5 · 2012: 2
- FWCI
- 4.95
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of General Internal Medicine (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Agency for Healthcare Research and Quality (HS-10123, R18 HS010123)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
- Health Sciences › Health Professions › General Health Professions › Primary Care and Health Outcomes
- Health Sciences › Medicine › Epidemiology › Chronic Disease Management Strategies
- Keywords
- type 2 diabetes, diabetes care quality, computer-based intervention, patient-centered care, primary care, laboratory screening, nutrition counseling, diabetes guidelines, Problem Areas in Diabetes, depression, RE-AIM framework, dissemination, translation research
- MeSH terms
- Attitude of Health Personnel, Counseling, Diabetes Mellitus, Type 2, Female, Follow-Up Studies, Foot, Humans, Male, Middle Aged, Physicians, Quality of Health Care, Outcome Assessment, Health Care, Patient-Centered Care
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