Skip to Main Content
Table 1—

Professional interventions versus usual care

ReferenceDesignIntervention i) intervention group c) control groupa) Number of providers b) Number of patients c) Number of practicesSettingFollow-up (months)Results
Conclusion
Patient outcomesProcess measures
Feder (21) 1995, U.K. RCT i) educational materials; local consensus processes; educational outreach visits; reminders c) no intervention a) 39 physicians supported by nurses b) 390 c) 24 primary care physician office, capitation and item of service 12 NA glyc (+) bp (+) weight (+) microv (+) process + 
Kinmonth (22) 1998, U.K. RCT i) educational materials/meetings; patient education (directed at ‘patient centered care’) c) educational materials/meetings; (focusing on use of guidelines and materials) a) 43 doctors supported by 64 nurses b) 250 c) 41 primary care physician office; capitation and item of service 12 glyc (0) bp (0) chol (0) BMI (−) alb (0) well (+) NA patient 0 (well [+]) 
Litzelman (23) 1993, U.S. RCT i) educational materials; reminders; patient education; behavioral contacts with patients; reminders for patients c) no intervention a) ? (physicians supported by nurses [education]) b) 396 c) 1 hospital-based academic primary care clinic; variable insurance arrangements* 12 microv (+)# microv (+)# patient + process + 
Lobach (24) 1994 Lobach (25) 1997; U.S. RCT i) local consensus processes; audit and feedback; reminders c) no intervention a) 30 primary care clinicians b) 359 c) 1 hospital-based academic primary care clinic; variable insurance arrangements NA glyc (−)# chol (+)# ur prot (+)# microv (0)# compl (+)# process + 
Mazze (26) 1994, U.S. RCT i) educational materials; educational meetings; local consensus processes; reminders c) no intervention a) 8 family practitioners b) 26 c) 1 free-standing academic primary care clinic; variable insurance arrangements glyc (+) visits (+/−) microv (+/−) educ (+/−) hlth surv (+/−) patient +/0nostatistical analyses but apositive trend) process +/−nostatistical analyses but apositive trend) 
Mazzuca (27) 1990, U.S. RCT i1) educational meetings; reminders i2) i1; clinical materials i3) i2; patient education c) educational meetings a) 98 internal medicine residents and faculty internists b) 2,791 c) 1 hospital-based academic primary care clinic; variable insurance arrangements 11 NA glyc (+) process + (i2) 
Palmer (28) 1990, U.S. RCT i) educational materials; local consensus procedures; audit and feedback c) no intervention a) ? b) 1,943 c) 8 free-standing nonacademic primary care practice; variable insurance arrangements 18 NA compl (0) process + 
Pill (30) 1998, U.K. RCT i) educational meetings; educational outreach visits c) no intervention a) ? b) 190 c) 29 primary care physician office; capitation and item of service 18 glyc (0)# bp (0)# BMI (0)# microv/macrov (0)# att pat (0)# patient 0 process 0 
Ward (31) 1996, Australia RCT i) educational materials; educational outreach visits; audit and feedback by interview c) educational materials; postal feedback a) 139 b) 386 c) ? primary care physician office; fee-for-service with small sessional and capitation payments NA glyc (+)within bp (0)within chol (+)within weight (+)within alb (+)within microv (+)within compl (+) process 
Carlson (32) 1991, Sweden RCT i) educational meetings; local consensus processes to identify problems and to create plans to improve diabetes care; educational outreach visits c) no intervention a) ? (physicians, nurses, nurse assistants managers, administrators, and laboratory technicians) b) 4,492 (measurements on professional practice) 566 (measurements on HbA1c) c) 34 primary health care center; salary 12 glyc (0)# glyc (+)# microv (+)# patient 0 process + 
Benjamin (20) 1999, U.S. CBA i) educational materials/meetings; local consensus processes; audit and feedback c) no intervention a) ? (physicians, residents, nurses, and nutritionist) b) 144 c) 2 free-standing academic primary care clinic; variable insurance arrangements 15 glyc (+)# chol (+)# microv (+)# patient + process +within 
Pieber (29) 1995, Austria CBA i) educational materials/meetings; patient education c) no intervention a) 14 GPs b) 94 c) 14 primary care physician office; fee-for-service 6  glyc (+)# bp (0)# chol (0)# BMI (+)# microv (+)#within NA patient + 
ReferenceDesignIntervention i) intervention group c) control groupa) Number of providers b) Number of patients c) Number of practicesSettingFollow-up (months)Results
Conclusion
Patient outcomesProcess measures
Feder (21) 1995, U.K. RCT i) educational materials; local consensus processes; educational outreach visits; reminders c) no intervention a) 39 physicians supported by nurses b) 390 c) 24 primary care physician office, capitation and item of service 12 NA glyc (+) bp (+) weight (+) microv (+) process + 
Kinmonth (22) 1998, U.K. RCT i) educational materials/meetings; patient education (directed at ‘patient centered care’) c) educational materials/meetings; (focusing on use of guidelines and materials) a) 43 doctors supported by 64 nurses b) 250 c) 41 primary care physician office; capitation and item of service 12 glyc (0) bp (0) chol (0) BMI (−) alb (0) well (+) NA patient 0 (well [+]) 
Litzelman (23) 1993, U.S. RCT i) educational materials; reminders; patient education; behavioral contacts with patients; reminders for patients c) no intervention a) ? (physicians supported by nurses [education]) b) 396 c) 1 hospital-based academic primary care clinic; variable insurance arrangements* 12 microv (+)# microv (+)# patient + process + 
Lobach (24) 1994 Lobach (25) 1997; U.S. RCT i) local consensus processes; audit and feedback; reminders c) no intervention a) 30 primary care clinicians b) 359 c) 1 hospital-based academic primary care clinic; variable insurance arrangements NA glyc (−)# chol (+)# ur prot (+)# microv (0)# compl (+)# process + 
Mazze (26) 1994, U.S. RCT i) educational materials; educational meetings; local consensus processes; reminders c) no intervention a) 8 family practitioners b) 26 c) 1 free-standing academic primary care clinic; variable insurance arrangements glyc (+) visits (+/−) microv (+/−) educ (+/−) hlth surv (+/−) patient +/0nostatistical analyses but apositive trend) process +/−nostatistical analyses but apositive trend) 
Mazzuca (27) 1990, U.S. RCT i1) educational meetings; reminders i2) i1; clinical materials i3) i2; patient education c) educational meetings a) 98 internal medicine residents and faculty internists b) 2,791 c) 1 hospital-based academic primary care clinic; variable insurance arrangements 11 NA glyc (+) process + (i2) 
Palmer (28) 1990, U.S. RCT i) educational materials; local consensus procedures; audit and feedback c) no intervention a) ? b) 1,943 c) 8 free-standing nonacademic primary care practice; variable insurance arrangements 18 NA compl (0) process + 
Pill (30) 1998, U.K. RCT i) educational meetings; educational outreach visits c) no intervention a) ? b) 190 c) 29 primary care physician office; capitation and item of service 18 glyc (0)# bp (0)# BMI (0)# microv/macrov (0)# att pat (0)# patient 0 process 0 
Ward (31) 1996, Australia RCT i) educational materials; educational outreach visits; audit and feedback by interview c) educational materials; postal feedback a) 139 b) 386 c) ? primary care physician office; fee-for-service with small sessional and capitation payments NA glyc (+)within bp (0)within chol (+)within weight (+)within alb (+)within microv (+)within compl (+) process 
Carlson (32) 1991, Sweden RCT i) educational meetings; local consensus processes to identify problems and to create plans to improve diabetes care; educational outreach visits c) no intervention a) ? (physicians, nurses, nurse assistants managers, administrators, and laboratory technicians) b) 4,492 (measurements on professional practice) 566 (measurements on HbA1c) c) 34 primary health care center; salary 12 glyc (0)# glyc (+)# microv (+)# patient 0 process + 
Benjamin (20) 1999, U.S. CBA i) educational materials/meetings; local consensus processes; audit and feedback c) no intervention a) ? (physicians, residents, nurses, and nutritionist) b) 144 c) 2 free-standing academic primary care clinic; variable insurance arrangements 15 glyc (+)# chol (+)# microv (+)# patient + process +within 
Pieber (29) 1995, Austria CBA i) educational materials/meetings; patient education c) no intervention a) 14 GPs b) 94 c) 14 primary care physician office; fee-for-service 6  glyc (+)# bp (0)# chol (0)# BMI (+)# microv (+)#within NA patient + 
*

In the U.S., most practices, whether hospital-based or not, care for patients under a variety of insurance arrangements: government (Medicare, Medicaid) or private (HMO or indemnity [fee-for-service]). ?, not reported; +, positive effect; 0, no effect; −, negative effect; +/−, effect unclear; NA, not applicable; #, possible unit of analysis error; within, differences are statistically tested within groups only, not between groups; alb, albumin; att pat, attendance patients; bp, blood pressure; comp, compliance care provider; CBA, controlled before-after study; creat, creatinine; glyc, glycemic control; HMO, health maintenance organization; hlth surv, health survey; hosp, hospitalizations; macrov, macrovascular complications; microv, microvascular complications; qual life, quality of life; RCT, randomized controlled trial.

Close Modal

or Create an Account

Close Modal
Close Modal