Evaluation of a short, interactive diabetes self-management program by pharmacists for type 2 diabetes.

OBJECTIVE: Numerous barriers prevent patients with type 2 diabetes (T2D) from completing a diabetes self-management program. We investigated whether patients with T2D exhibited improved clinical outcomes after attending a relatively short, interactive diabetes self-management program conducted by pharmacist diabetes educators, compared to a physician's usual care. RESULTS: We retrospectively analyzed the data of adults with T2D who attended a diabetes self-management program (≥ 1 group meeting or individual appointment followed by a telephone interview from a pharmacist diabetes educator between May 2010 and Dec. 2012; n = 513) and compared their outcomes with those of T2D patients who received only their physician's usual care (n = 857). Each patient's A1C was assessed at baseline, 3 months, and 6 months post-intervention. The mean [SD] reduction in A1C percentage points in the T2D patients was significantly greater in the diabetes self-management program group compared to the physician's usual care group at both 3 months (- 0.8% [1.5] vs. - 0.2% [0.9], p < 0.001) and 6 months post-intervention (- 0.6% [1.3] vs. - 0.2% [1.1], p < 0.001). T2D patients significantly improved their glycemic control within 3-6 months of attending the diabetes self-management program compared to patients who only received their physician's usual care.

Improving prompt effectiveness in diabetes care: an intervention study.

Electronic medical records (EMRs) should support clinical decision making to further quality care delivery. This study describes 1 academic medical group's efforts to leverage their EMR's decision-support functionality to improve quality care delivery. A nested, time-series, quasiexperimental design compared 3 different implementation strategies for EMR prompting at 5 primary care clinics in a single academic medical group. The primary outcome was the ordering of all indicated diabetes monitoring tests before the end of the visit. The authors analyzed 16 511 visits performed on 3730 patients. The rate of ordering all indicated tests at the time of the visit increased from 29% with no prompts to 49% (P < .001) with appropriately designed prompts and training support. EMR-generated prompts may be more likely to increase ordering of recommended monitoring tests when clinic workflow, staff training, and medical culture are incorporated into the prompt delivery.