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IMPLEMENTING CLINICAL GUIDELINES IN THE TREATMENT OF DIABETES MELLITUS IN GENERAL PRACTICE

Evaluation of Effort, Process, and Patient Outcome Related to Implementation of a Computer-based Decision Support System

Published online by Cambridge University Press:  04 May 2001

Irene Hetlevik ,
Jostein Holmen ,
Øystein Krüger ,
Pål Kristensen ,
Hege Iversen  and
Kristian Furuseth
Irene Hetlevik
Affiliation:
National Institute of Public Health, Ranheim Health Center, and Norwegian University of Science and Technology
Jostein Holmen
Affiliation:
National Institute of Public Health and Norwegian University of Science and Technology
Øystein Krüger
Affiliation:
National Institute of Public Health
Pål Kristensen
Affiliation:
Ranheim Health Center
Hege Iversen
Affiliation:
InfoTech A/S
Kristian Furuseth
Affiliation:
Spesiallegetjenesten
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Abstract

Objectives: To evaluate the implementation of clinical guidelines for diabetes mellitus in general practice with a specific computer-based clinical decision support system (CDSS) as part of the intervention.

Methods: Randomized study with health center as unit. General practice in Sør- and Nord-Trøndelag counties in Norway, 380,000 inhabitants. Seventeen health centers with 24 doctors and 499 patients with diabetes mellitus were in the intervention group and 12 health centers with 29 doctors and 535 patients were in the control group. Main outcome measures were group differences in fractions of patients without registrations (process evaluation) and mean group differences for the same variables (patient outcome evaluation).

Results: Statistically significant group differences were experienced for fractions of patients without registration of cigarette smoking (intervention group, 82.6%; control group 94.5%), body mass index (78.2% vs. 93.0%), and sufficient registrations for calculation of risk score for myocardial infarction (91.1% vs. 98.3%); all during 18 months. Large center variations were shown for all variables. The only statistically significant group difference was −2.3 mm Hg (95% CI, −3.8, −0.8) in diastolic blood pressure in favor of the intervention group. Statistically insignificant differences in favor of the intervention group were HbA1c, −0.1% (95% CI, −0.4, 0.1), systolic blood pressure, −1.2 mm Hg (95% CI, −4.4, 2.0). Statistically insignificant differences in favor of the control group were fractions of smokers, +3.0% (95% CI, −4.0, 10.0), body mass index, +0.3 kg/m2 (95% CI, −0.8, 1.4), risk score in female +0.1 (95% CI, −5.1, 5.2), and risk score in male +2.6 (95% CI, −14.2, 19.5).

Conclusions: Implementation of clinical guidelines for diabetes mellitus in general practice, by means of a CDSS and several procedures for implementation, did not result in a clinically significant change in doctors' behavior or in patient outcome.

Keywords

Diabetes mellitusGeneral practiceImplementationPractice guidelines
Type
Research Article
Information
International Journal of Technology Assessment in Health Care , Volume 16 , Issue 1 , January 2000 , pp. 210 - 227
Copyright
© 2000 Cambridge University Press

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