PDB85 Dispensed Insulin Dose before and after Sodium-Glucose Transport Protein 2 Inhibitor Initiation in Diabetes Mellitus Type 2 Patients in Netherlands - a Retrospective Database Study

Abstract Background A new organisation at the primary level, called model practices, introduces a 0.5 full-time equivalent nurse practitioner as a regular member of the team. Nurse practitioners are in charge of registers of chronic patients, and implement an active approach into medical care. Selected quality indicators define the quality of management. The majority of studies confirm the effectiveness of the extended team in the quality of care, which is similar or improved when compared to care performed by the physician alone. The aim of the study is to compare the quality of management of patients with diabetes mellitus type 2 before and after the introduction of model practices. Methods A cohort retrospective study was based on medical records from three practices. Process quality indicators, such as regularity of HbA1c measurement, blood pressure measurement, foot exam, referral to eye exam, performance of yearly laboratory tests and HbA1c level before and after the introduction of model practices were compared. Results The final sample consisted of 132 patients, whose diabetes care was exclusively performed at the primary care level. The process of care has significantly improved after the delivery of model practices. The most outstanding is the increase of foot exam and HbA1c testing. We could not prove better glycaemic control (p>0.1). Nevertheless, the proposed benchmark for the suggested quality process and outcome indicators were mostly exceeded in this cohort. Conclusion The introduction of a nurse into the team improves the process quality of care. Benchmarks for quality indicators are obtainable. Better outcomes of care need further confirmation.

Download Full-text

Educational intervention to improve the competence of Mexican physicians to provide nutritional management for diabetes mellitus type 2

Revista de Salud Pública ◽

10.15446/rsap.v20n6.65550 ◽

2018 ◽

Vol 20 (6) ◽

pp. 711-717

Author(s):

Carlos E. Cabrera-Pivaral ◽

René C. Crocker-Sagástume ◽

Marco A. Zavala-González ◽

Priscilla Muñiz-Mendoza

Keyword(s):

Diabetes Mellitus ◽

Educational Intervention ◽

Clinical Competence ◽

Diabetes Mellitus Type 2 ◽

Family Physicians ◽

Diabetes Mellitus Type ◽

Control Group ◽

Nutritional Management ◽

Before And After

Objective To evaluate the effect of a participative educational intervention on the clinical competence of Mexican family physicians regarding the nutritional management of patients with diabetes mellitus Type 2.Materials and Methods Quasi-experimental study with a before-and-after control group. Convenience sample included 60 family physicians distributed in two social security primary health care units, randomly selected: 30 in the “A” unit and 30 in the “B” unit. Unit “A” was assigned randomly as control group, and “B” unit as intervention group. The intervention consisted of a theoretical-practical course-workshop that lasted six months where real cases were discussed and solved. Clinical competence was evaluated by means of an instrument designed ex professo, with a maximum theoretical value of 100 and 94% reliability according to the Kuder-Richardson test. Medians of clinical competence were compared among groups, before and after intervention, using the Mann-Whitney U test, while frequencies distribution of clinical competence level were analyzed with the Kolmogorov–Smirnov test (p≤0.05).Results Overall medians and intervals for unit “A” were 28 (9-45) pre-intervention and 34 (11-51) pos-intervention, with before-after difference p>0.05; for unit “B”, values were 32 (12-50) pre-intervention, 61 (36-82) pos-intervention, and before-after difference p≤0.05. No significant differences were found among groups pre-intervention (p>0.05), although they were observed pos-intervention (p≤0.05).Conclusions The educational intervention evaluated proved to improve, in a statistically significant way, the overall and by dimensions clinical competence level of Mexican family physicians for nutritional management of patients with diabetes mellitus type 2.

Download Full-text