Interventions to Improve the Management of Diabetes in Primary Care, Outpatient, and Community Settings

Renders, Carry M.; Valk, Gerlof D.; Griffin, Simon J.; Wagner, Edward H.; Eijk van, Jacques ThM.; Assendelft, Willem J.J.

doi:10.2337/diacare.24.10.1821

Cited by 1,066Diabetes Management and EducationHealth Policy Implementation SciencePrimary Care and Health Outcomes

Interventions to Improve the Management of Diabetes in Primary Care, Outpatient, and Community Settings

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Renders, Carry M., Valk, Gerlof D., Griffin, Simon J., Wagner, Edward H., Eijk van, Jacques ThM., Assendelft, Willem J.J.·2001·Diabetes Care

DOI 10.2337/diacare.24.10.1821

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Abstract

OBJECTIVE—To review the effectiveness of interventions targeted at health care professionals and/or the structure of care in order to improve the management of diabetes in primary care, outpatient, and community settings. RESEARCH DESIGN AND METHODS—A systematic review of controlled trials evaluating the effectiveness of interventions targeted at health care professionals and aimed at improving the process of care or patient outcomes for patients with diabetes was performed. Standard search methods of the Cochrane Effective Practice and Organization of Care Group were used. RESULTS—A total of 41 studies met the inclusion criteria. The studies identified were heterogeneous in terms of interventions, participants, settings, and reported outcomes. In all studies, the interventions were multifaceted. The interventions were targeted at health care professionals only in 12 studies, at the organization of care only in 9 studies, and at both in 20 studies. Complex professional interventions improved the process of care, but the effect on patient outcomes remained less clear because such outcomes were rarely assessed. Organizational interventions that facilitated the structured and regular review of patients also showed a favorable effect on process measures. Complex interventions in which patient education was added and/or the role of a nurse was enhanced led to improvements in patient outcomes as well as the process of care. CONCLUSIONS—Multifaceted professional interventions and organizational interventions that facilitate structured and regular review of patients were effective in improving the process of care. The addition of patient education to these interventions and the enhancement of the role of nurses in diabetes care led to improvements in patient outcomes and the process of care.

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Interventions that were complex were often associated with lower adoption.
“Interventions that were complex were often associated with lower adoption [3, 35, 39, 87, 88].”
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Katon, W. J., Russo, J. E., Lin, E. H. B., Heckbert, S. R., Karter, A. J., Williams, L. H., Ciechanowski, P. S., Ludman, E. J., & Korff, M. V. (2009) · Psychosomatic Medicine · doi:10.1097/psy.0b013e3181bd8f55 · Cited by 141 · see citing works

Interventions to improve the management of diabetes mellitus in primary care, outpatient and community settings
Renders, C. M., Valk, G. D., Griffin, S. J., Wagner, E. H., van Eijk, J. T. M., & Assendelft, W. J. (2000) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd001481 · Cited by 492 · see citing works
Self-citation
Interventions in the Delivery of Outpatient Diabetes Care: A systematic review of the literature 2001-2005
Ashley, T. (2019) · Carolina Digital Repository (University of North Carolina at Chapel Hill) · doi:10.17615/adrc-vf34
Structured diabetes care leads to differences in organization of care in general practices: the healthcare professional and patient perspective
Fokkens, A., Wiegersma, P. A., van der Meer, K., & Reijneveld, S. A. (2011) · BMC Health Services Research · doi:10.1186/1472-6963-11-113 · Cited by 10 · see citing works
Response to Shandro et al.
Renders, C. M., & Valk, G. D. (2002) · Diabetes Care · doi:10.2337/diacare.25.5.941-a · Cited by 3 · see citing works
Self-citation
Patient-oriented intervention in addition to centrally organised checkups improves diabetic patient outcome in primary care
Meulepas, M. A., Braspenning, J. C. C., Grauw, W. J. D., Lucas, A. E. M., WIJKEL, D., & Grol, R. P. T. M. (2008) · BMJ Quality & Safety · doi:10.1136/qshc.2006.021204 · Cited by 12 · see citing works

Authors: Renders, C. M., Valk, G. D., Griffin, S. J., Wagner, E. H., Eijk van, J. T., & Assendelft, W. J. J.
Affiliations: Amsterdam UMC Location Vrije Universiteit Amsterdam (NL)
University of Cambridge (GB)
Group Health Cooperative (US)
Department of Medical Sociology, Universiteit van Maastricht, Maastricht, the Netherlands
Amsterdam UMC Location University of Amsterdam (NL)
ORCID: Renders, Carry M.
Valk, Gerlof D.
Griffin, Simon J.
Wagner, Edward H.
Assendelft, Willem J.J.
Venue: Diabetes Care
Publisher: American Diabetes Association
Published: 2001-10-01
Volume: 24
Issue: 10
Pages: 1821-1833
ISSN: 0149-5992 (ISSN-L)
1935-5548
DOI: 10.2337/diacare.24.10.1821
OpenAlex: W2117186085
Cited by: 1,066
References: 73
Citations by year: 2026: 9 · 2025: 10 · 2024: 8 · 2023: 13 · 2022: 18 · 2021: 24 · 2020: 21 · 2019: 38 · 2018: 27 · 2017: 40 · 2016: 46 · 2015: 62 · 2014: 65 · 2013: 60 · 2012: 63
FWCI: 5.00
Type: journal article
Language: en
Open access: bronze
doi.org
Locations: Diabetes Care (publishedVersion)
PubMed (publishedVersion)
Funders: Nederlandse Organisatie voor Wetenschappelijk Onderzoek
Topics: Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
Health Sciences › Health Professions › General Health Professions › Primary Care and Health Outcomes
Keywords: diabetes management, primary care, outpatient care, community settings, organizational interventions, process of care, patient outcomes, multicomponent intervention, patient education, nursing role
MeSH terms: Ambulatory Care, Community Health Services, Diabetes Mellitus, Humans, Patient Education as Topic, Primary Health Care, Quality of Health Care, Treatment Outcome, Controlled Clinical Trials as Topic

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Interventions to Improve the Management of Diabetes in Primary Care, Outpatient, and Community Settings

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