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TRINE LIGNELL GULDBERG 14 MAY, 2009

DEPT. OF GENERAL PRACTICESCHOOL OF PUBLIC HEALTHAARHUS UNIVERSITY

Development and evaluation of an electronic feedback system, a tool for optimizing diabetes care in general practice.

T.L. Guldberg(1), P. Vedsted(2), J.K. Kristensen(1), V. Zoffmann(3), T. Lauritzen(1)

Institute of Public Health, Aarhus University

1)Dept. of General Practice 2)Research Unit for General Practice,3) Steno Diabetes center

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TRINE LIGNELL GULDBERG 14 MAY, 2009

DEPT. OF GENERAL PRACTICESCHOOL OF PUBLIC HEALTHAARHUS UNIVERSITY

Aim:

To evaluate the effect of an electronic feedback system to GPs concerning their type 2-diabetes care in a randomized intervention design.

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TRINE LIGNELL GULDBERG 14 MAY, 2009

DEPT. OF GENERAL PRACTICESCHOOL OF PUBLIC HEALTHAARHUS UNIVERSITY

Intervention:

90 general practitioners clinics have been randomised to either admission or no admission to an electronic feedback system. GPs cared for 5148 people with type 2-diabetes

Intervention nested in Region Syddanmark and Region Midtjylland.

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TRINE LIGNELL GULDBERG 14 MAY, 2009

DEPT. OF GENERAL PRACTICESCHOOL OF PUBLIC HEALTHAARHUS UNIVERSITY

Electronic feedback system:

Distributed on CD Rom,Initially installed by visiting project worker.Updated quarterly.

Launched in 2007 and ran for one year.

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TRINE LIGNELL GULDBERG 14 MAY, 2009

DEPT. OF GENERAL PRACTICESCHOOL OF PUBLIC HEALTHAARHUS UNIVERSITY

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TRINE LIGNELL GULDBERG 14 MAY, 2009

DEPT. OF GENERAL PRACTICESCHOOL OF PUBLIC HEALTHAARHUS UNIVERSITY

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TRINE LIGNELL GULDBERG 14 MAY, 2009

DEPT. OF GENERAL PRACTICESCHOOL OF PUBLIC HEALTHAARHUS UNIVERSITY

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TRINE LIGNELL GULDBERG 14 MAY, 2009

DEPT. OF GENERAL PRACTICESCHOOL OF PUBLIC HEALTHAARHUS UNIVERSITY

Evaluation:

Quantitative evaluation on register data and log data

Qualitative evaluation on interview data with intervention GPs

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TRINE LIGNELL GULDBERG 14 MAY, 2009

DEPT. OF GENERAL PRACTICESCHOOL OF PUBLIC HEALTHAARHUS UNIVERSITY

Primary output:

Usage of the electronic feedback system• Used at overall level?• Used at individual patient level?

Impact of system in intervention clinics

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TRINE LIGNELL GULDBERG 14 MAY, 2009

DEPT. OF GENERAL PRACTICESCHOOL OF PUBLIC HEALTHAARHUS UNIVERSITY

InitialLog data

Interview data

Intermediate

Interview data

Long term

Register data:• Data on laboratory

tests• Data on medicinal

use• Data on diabetes-

related eye examinations

Interview data

Outcome

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TRINE LIGNELL GULDBERG 14 MAY, 2009

DEPT. OF GENERAL PRACTICESCHOOL OF PUBLIC HEALTHAARHUS UNIVERSITY

InitialGPs used the sortable lists to get an overview of the patient population.

Interview data

Intermediate

Interview data

Long term

Register data:• Data on laboratory

tests• Data on medicinal

use• Data on diabetes-

related eye examinations

Interview data

Outcome

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TRINE LIGNELL GULDBERG 14 MAY, 2009

DEPT. OF GENERAL PRACTICESCHOOL OF PUBLIC HEALTHAARHUS UNIVERSITY

InitialGPs used the sortable lists to get an overview of the patient population.

The lists generated attention to problem areas in the diabetes care.

Intermediate

Interview data

Long term

Register data:• Data on laboratory

tests• Data on medicinal

use• Data on diabetes-

related eye examinations

Interview data

Outcome

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TRINE LIGNELL GULDBERG 14 MAY, 2009

DEPT. OF GENERAL PRACTICESCHOOL OF PUBLIC HEALTHAARHUS UNIVERSITY

InitialGPs used the sortable lists to get an overview of the patient population.

The lists generated attention to problem areas in the diabetes care.

IntermediateIncreased attention led to :

• Organisational changes in two of four GP clinics

• Additional education of practice nurses

• Allocation of diabetes care to practice nurses,

Long term

Register data:• Data on laboratory

tests• Data on medicinal

use• Data on diabetes-

related eye examinations

Interview data

Outcome

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TRINE LIGNELL GULDBERG 14 MAY, 2009

DEPT. OF GENERAL PRACTICESCHOOL OF PUBLIC HEALTHAARHUS UNIVERSITY

InitialGPs used the sortable lists to get an overview of the patient population.

The lists generated attention to problem areas in the diabetes care.

IntermediateIncreased attention led to :

• Organisational changes in two of four GP clinics

• Additional education of practice nurses

• Allocation of diabetes care to practice nurses,

Long termIntervention GPs have more:• Cholesterol controls

(p=0,036)• Patient eye

examinations (p=0,005)

• Use of statins (p=0,016), metformin (p=0,004) and ACE inhibitors (p=0,008)

Interview data

Outcome

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TRINE LIGNELL GULDBERG 14 MAY, 2009

DEPT. OF GENERAL PRACTICESCHOOL OF PUBLIC HEALTHAARHUS UNIVERSITY

InitialGPs used the sortable lists to get an overview of the patient population.

The lists generated attention to problem areas in the diabetes care.

IntermediateIncreased attention led to :

• Organisational changes in two of four GP clinics

• Additional education of practice nurses

• Allocation of diabetes care to practice nurses,

Long termIntervention GPs have more:• Cholesterol controls

(p=0,036)• Patient eye

examinations (p=0,005)

• Use of statins (p=0,016), metformin (p=0,004) and ACE inhibitors (p=0,008)

• GPs felt liberated by allocating diabetes care to nurses,

• GPs spend more time on other patient groups.

Outcome

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TRINE LIGNELL GULDBERG 14 MAY, 2009

DEPT. OF GENERAL PRACTICESCHOOL OF PUBLIC HEALTHAARHUS UNIVERSITY

Problems discovered:

No usage on individual patient level due to:• No real time data• Practice in-house IT systems superior in data and familiar to use.

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TRINE LIGNELL GULDBERG 14 MAY, 2009

DEPT. OF GENERAL PRACTICESCHOOL OF PUBLIC HEALTHAARHUS UNIVERSITY

Perspectives:• An electronic feedback system containing sortable lists generated new

insight into the quality of diabetes care in GP clinics• New attention to quality of diabetes care led to organisational changes

in GP clinics, allocating diabetes care to practice nurses.• An electronic feedback system led to better quality of care for people

with Type 2-Diabetes in general practice.

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TRINE LIGNELL GULDBERG 14 MAY, 2009

DEPT. OF GENERAL PRACTICESCHOOL OF PUBLIC HEALTHAARHUS UNIVERSITY

Thank you.