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Cited by 108Diabetes Management and EducationDiabetes Treatment and ManagementPrimary Care and Health Outcomes

An Endocrinologist-Supported Intervention Aimed at Providers Improves Diabetes Management in a Primary Care Site

Phillips, Lawrence S., Ziemer, David C., Doyle, Joyce P., Barnes, Catherine S., Kolm, Paul, Branch, William T., Caudle, Jane M., Cook, Curtiss B. +8 more·2005·Diabetes Care
DOI 10.2337/diacare.28.10.2352
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Abstract

OBJECTIVE: Management of diabetes is frequently suboptimal in primary care settings, where providers often fail to intensify therapy when glucose levels are high, a problem known as clinical inertia. We asked whether interventions targeting clinical inertia can improve outcomes. RESEARCH DESIGN AND METHODS: A controlled trial over a 3-year period was conducted in a municipal hospital primary care clinic in a large academic medical center. We studied all patients (4,138) with type 2 diabetes who were seen in continuity clinics by 345 internal medicine residents and were randomized to be control subjects or to receive one of three interventions. Instead of consultative advice, the interventions were hard copy computerized reminders that provided patient-specific recommendations for management at the time of each patient's visit, individual face-to-face feedback on performance for 5 min every 2 weeks, or both. RESULTS: Over an average patient follow-up of 15 months within the intervention site, improvements in and final HbA1c (A1C) with feedback + reminders (deltaA1C 0.6%, final A1C 7.46%) were significantly better than control (deltaA1C 0.2%, final A1C 7.84%, P < 0.02); changes were smaller with feedback only and reminders only (P = NS vs. control). Trends were similar but not significant with systolic blood pressure (sBP) and LDL cholesterol. Multivariable analysis showed that the feedback intervention independently facilitated attainment of American Diabetes Association goals for both A1C and sBP. Over a 2-year period, overall glycemic control improved in the intervention site but did not change in other primary care sites (final A1C 7.5 vs. 8.2%, P < 0.001). CONCLUSIONS: Feedback on performance aimed at overcoming clinical inertia and given to internal medicine resident primary care providers improves glycemic control. Partnering generalists with diabetes specialists may be important to enhance diabetes management in other primary care settings.

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  • Phillips 2005 found little or no differences in haemoglobin A1C, systolic blood pressure, and low-density lipoprotein cholesterol levels when adding reminders to audit and feedback (median adjusted change relative to baseline performance in the audit and feedback alone arm = 2%; no P value reported).

    “Phillips 2005 found little or no differences in haemoglobin A1C, systolic blood pressure, and low‐density lipoprotein cholesterol levels (median adjusted change relative to baseline performance in the audit and feedback alone arm = 2%; no P value reported).”

    From Audit and feedback: effects on professional practice and healthcare outcomes (2012) · cites this paper as Phillips 2005

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Authors
Phillips, L. S., Ziemer, D. C., Doyle, J. P., Barnes, C. S., Kolm, P., Branch, W. T., Caudle, J. M., Cook, C. B., Dunbar, V. G., El-Kebbi, I. M., Gallina, D. L., Hayes, R. P., Miller, C. D., Rhee, M. K., Thompson, D. M., & Watkins, C.
Affiliations
  • Emory University (US)
  • Mayo Clinic (US)
  • Division of Endocrinology and Metabolism, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
  • Eli Lilly (United States) (US)
  • Georgia State University (US)
ORCID
Venue
Diabetes Care
Publisher
American Diabetes Association
Published
2005-10-01
Volume
28
Issue
10
Pages
2352-2360
ISSN
  • 0149-5992 (ISSN-L)
  • 1935-5548
DOI
10.2337/diacare.28.10.2352
OpenAlex
W2153111497
Cited by
108
References
71
Citations by year
2025: 1 · 2023: 3 · 2022: 1 · 2021: 3 · 2020: 2 · 2019: 4 · 2018: 2 · 2017: 6 · 2016: 5 · 2015: 5 · 2014: 7 · 2013: 8 · 2012: 10
FWCI
6.42
Type
journal article
Language
en
Open access
closed
Locations
  • Diabetes Care (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • Agency for Healthcare Research and Quality (HS 07922)
  • National Institute of Diabetes and Digestive and Kidney Diseases (DK0-66204, DK062668, DK07298, F32DK062668, R18DK066204)
  • National Center for Research Resources (RR00039, RR017643, K12RR017643)
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
  • Health Sciences › Health Professions › General Health Professions › Primary Care and Health Outcomes
Keywords
type 2 diabetes, clinical inertia, glycemic control, HbA1c, performance feedback, computerized reminders, internal medicine residents, primary care, blood pressure, LDL cholesterol
MeSH terms
Academic Medical Centers, Adult, Aged, Black or African American, Diabetes Mellitus, Type 2, Endocrinology, Female, Follow-Up Studies, Glycated Hemoglobin, Humans, Hyperglycemia, Internship and Residency, Male, Middle Aged, Primary Health Care, Prospective Studies, Program Evaluation

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