The effect of introducing prompted, systematic, protocol-based diabetic care in a practice: 18 months of improvement

Abstract

Objective: to evaluate the impact of prompted, systematic, protocol-based care for a general practice diabetic population on glycaemic control, control of hyperlipidaemia and hypertension, and to assess the quality of diabetic care provided. Setting: one general practice in Nottingham, UK. Design: baseline and follow-up audit and retrospective cohort study. Subjects: all diabetic patients registered with the practice between 1 May 1997 and 1 November 1998. Outcome measures: glycaemic (fasting plasma glucose and HbA1c), lipid (serum cholesterol and triglyceride concentrations) and blood pressure control; achievement of process measures relating to diabetic care. Results: glycaemic control and serum cholesterol levels improved significantly over an 18 month period, but there was no significant improvement in triglyceride levels or in blood pressure control. At follow-up the glycaemic and blood pressure control was similar to that achieved in the intensive arm of the UKPDS study. At least 87% of patients had all elements of the recommended annual review. Conclusions: improvements in glycaemic and lipid control can be achieved within a short time scale in primary care. There are considerable workload implications to achieving such improvement. The sustainability of improvements in control in primary care is not known, and longer term follow-up is required to establish this. Copyright © 2000 John Wiley & Sons, Ltd.