Steven A. Smith, MD
Do brief educational messages attached to laboratory test results improve outcomes in patients with diabetes mellitus (DM)?
2-phase, cluster randomized controlled trial. Current Controlled Trials ISRCTN2186314.
34 months for phase 1 and 24 months for phase 2.
Primary care practices in Newcastle upon Tyne, England, UK.
8690 patients (> 50% men, mean age > 62 y) who had DM and received care in 1 of 32 randomized practices.
Brief messages, usually < 30 words, added to paper or electronic laboratory test results provided to clinicians (general practitioners and nurses), or no messages. In phase 1, clusters were randomized to receive messages about appropriate glycemic treatment, conditional on patient hemoglobin A1c (HbA1c) results (n = 18 practices), or not (n = 17 practices); and to receive unconditional messages about cholesterol control attached to HbA1c test results (n = 18 practices), or not (n = 17 practices). In phase 2, clusters were randomized to receive messages about blood pressure (BP) targets conditional on patient albumin–creatinine ratio (ACR) (n = 17 practices), or not (n = 17 practices); and to receive unconditional messages with foot examination reminders attached to ACR test reports (n = 17 practices), or not (n = 17 practices).
Practice mean levels of HbA1c, cholesterol, and BP, and number of patients who had foot inspections.
32 of 35 practices.
Practices that received BP target messages had a greater reduction in diastolic BP than those that did not (Table). Practices that received foot inspection messages recorded more foot inspections than practices that did not (relative benefit increase 26%, 95% CI 18 to 36). Intervention and control groups did not differ for mean HbA1c level, HbA1c within target level (< 6.35%), mean cholesterol level, cholesterol within target level (≤ 5 mmol/L), mean systolic BP, or BP within target level (≤ 140/80 mm Hg ) (Table).
Brief educational messages attached to laboratory test reports improved diastolic blood pressure (BP) and the number of patients who had foot inspection but not hemoglobin A1c levels, cholesterol levels, or systolic BP in patients with diabetes mellitus.
Educational messages attached to laboratory reports vs no messages for diabetes care‡
‡Hb = hemoglobin; other abbreviations defined in Glossary.
§A positive number indicates a relative increase in the intervention group.
Smith SA. Educational messages on laboratory results improved diastolic BP but not systolic BP, HbA1c, or cholesterol in diabetes. Ann Intern Med. ;156:JC5–12. doi: 10.7326/0003-4819-156-10-201205150-02012
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Published: Ann Intern Med. 2012;156(10):JC5-12.
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