Effect of an educational intervention in primary care physicians on the compliance of indicators of good clinical practice in the treatment of type 2 diabetes mellitus [OBTEDIGA project]

Vidal-Pardo, José I.; Pérez-Castro, Teresa-Rosalía; López-Álvarez, X. L.; Santiago-Pérez, María Isolina; García-Soidán, Francisco Javier; Muñiz, Javier

doi:10.1111/ijcp.12145

Cited by 18 publications

(16 citation statements)

References 39 publications

(50 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…People with diabetes at risk for foot ulceration who are cared for by professionals without specific expertise on diabetic foot disease should be referred by these professionals to integrated foot care services. Educational interventions targeting health care professionals to improve completion rates of yearly foot examinations and to improve knowledge of health care professionals not daily involved in diabetic foot care may be important, but the effectiveness of such education is unclear . Teams that provide integrated foot care may perform educational outreach activities to health care professionals in primary or secondary care.…”

Section: Integrated Foot Carementioning

confidence: 99%

Guidelines on the prevention of foot ulcers in persons with diabetes (IWGDF 2019 update)

Bus

Lavery

Monteiro‐Soares

et al. 2020

Diabetes Metabolism Res

375

609

View full text Add to dashboard Cite

The International Working Group on the Diabetic Foot (IWGDF) has published evidence‐based guidelines on the prevention and management of diabetic foot disease since 1999. This guideline is on the prevention of foot ulceration in persons with diabetes and updates the 2015 IWGDF prevention guideline. We followed the GRADE methodology to devise clinical questions and critically important outcomes in the PICO format, to conduct a systematic review of the medical‐scientific literature, and to write recommendations and their rationale. The recommendations are based on the quality of evidence found in the systematic review, expert opinion where evidence was not available, and a weighing of the benefits and harms, patient preferences, feasibility and applicability, and costs related to the intervention. We recommend to screen a person at very low risk for ulceration annually for loss of protective sensation and peripheral artery disease and persons at higher risk at higher frequencies for additional risk factors. For preventing a foot ulcer, educate the at‐risk patient about appropriate foot self‐care and treat any pre‐ulcerative sign on the foot. Instruct moderate‐to‐high risk patients to wear accommodative properly fitting therapeutic footwear, and consider instructing them to monitor foot skin temperature. Prescribe therapeutic footwear that has a demonstrated plantar pressure relieving effect during walking to prevent plantar foot ulcer recurrence. In patients that fail non‐surgical treatment for an active or imminent ulcer, consider surgical intervention; we suggest not to use a nerve decompression procedure. Provide integrated foot care for high‐risk patients to prevent ulcer recurrence. Following these recommendations will help health care professionals to provide better care for persons with diabetes at risk of foot ulceration, to increase the number of ulcer‐free days, and to reduce the patient and health care burden of diabetic foot disease.

show abstract

Section: Integrated Foot Carementioning

confidence: 99%

Guidelines on the prevention of foot ulcers in persons with diabetes (IWGDF 2019 update)

Bus

Lavery

Monteiro‐Soares

et al. 2020

Diabetes Metabolism Res

375

609

View full text Add to dashboard Cite

show abstract

“…Vidal‐Pardo and colleagues performed a combined retrospective and prospective cohort study with low risk of bias . They included 103 primary care physicians and 5868 of their patients and investigated the effect of an educational intervention on indicators of good clinical practice.…”

Section: Structured Education Aimed At Health Care Professionalsmentioning

confidence: 99%

“…Vidal-Pardo and colleagues performed a combined retrospective and prospective cohort study with low risk of bias. 29 In nine noncontrolled studies with a pre-post design, mixed outcomes were reported. Some found an increase in yearly foot examinations and self-reported knowledge, [30][31][32][33][34] while others reported improvements in some centres/participants only or no differences postintervention.…”

Section: Structured Education Aimed At Health Care Professionalsmentioning

confidence: 99%

Treatment of modifiable risk factors for foot ulceration in persons with diabetes: a systematic review

Netten

Sacco

Lavery

et al. 2020

Diabetes Metabolism Res

View full text Add to dashboard Cite

Background Prevention of diabetic foot ulcers is important. Preventative treatment mostly targets and aims to improve modifiable risk factors of foot ulceration. While effectiveness of interventions in ulcer prevention has been systematically reviewed, their effectiveness in improving modifiable risk factors is unknown. Methods The available medical scientific literature in PubMed, Excerpta Medica Database, and the Cochrane database was searched for original research studies on six interventions to treat modifiable risk factors for diabetic foot ulceration (ie, education for patients; education for professionals; self‐management; pre‐ulcer treatment; orthotic interventions; and foot‐ and mobility‐related exercises). We assessed interventions for eight outcomes (ie, patients' knowledge; treatment adherence; professionals' knowledge; pre‐ulcers; mechanical stress; neuropathy symptoms; foot/ankle joint mobility; and foot function). Both controlled and noncontrolled studies were selected. Data from controlled studies were assessed for methodological quality by two independent reviewers and extracted and presented in evidence and risk of bias tables. Results We included 72 publications (26 with a controlled study design and 46 noncontrolled). We found that structured education may improve foot self‐care behaviour of patients, yearly foot examinations, and foot disease knowledge of health care professionals. Callus removal reduces peak plantar pressure. Custom‐made therapeutic footwear can be effective in reducing plantar pressure and may reduce callus. Foot‐ and mobility‐related exercises may improve neuropathy symptoms and foot and ankle joint range of motion, while they do not seem to reduce peak plantar pressure; evidence for their effect on foot strength is conflicting. Conclusions Structured education for patients and health care professionals, callus removal, custom‐made therapeutic footwear, and foot‐ and mobility‐related exercises may be beneficial for improving modifiable risk factors for foot ulceration. However, we generally found low quality of evidence for interventions targeting modifiable risk factors for ulceration in persons with diabetes, with frequently inconsistent or limited results available per intervention and outcome.

show abstract

“…He concluded that explicit guidelines do improve clinical practice but with considerable variations in performance. Other educational tools that improve knowledge have also been shown to positively affect clinical outcomes in small studies of physicians who care for patients with diabetes [18, 19]. The DIABEDS trial demonstrated that a physician education program among internal medicine residents could lead to objective improvements in fasting glucose, HbA1c, and body weight among their patients [20].…”

Section: Discussionmentioning

confidence: 99%

The use of clinical guidelines highlights ongoing educational gaps in physicians’ knowledge and decision making related to diabetes

et al. 2014

View full text Add to dashboard Cite

BackgroundClinical guidelines for type 2 diabetes are a resource for providers to manage their patients and may help highlight specific areas in need of further education and training. We sought to determine how often guidelines are used and the relationship to physicians’ diabetes-related knowledge and decision making.MethodsExisting users of electronic clinical support tools were invited to complete an online questionnaire. A knowledge score was calculated for five questions related to prevention of diabetes and treatment of its complications. We explored the association of clinical guideline use with diabetes-related knowledge and self-reported decision making using logistic regression models, adjusted for key covariates.ResultsOf 383 physicians completing the questionnaire, 53% reported using diabetes guidelines routinely. Mean diabetes knowledge score for guideline users (GU) was significantly higher than non-guideline users (NGU) (3.37 ± 0.072 vs. 2.76 ± 0.084; p < 0.001). GU were significantly more likely to report a good understanding of type 2 diabetes medications (OR = 2.99, 95% CI 1.95-4.61; p < 0.001). GU were less likely to report their unfamiliarity with insulin as an important barrier to early insulin use (OR = 0.41, 0.21-0.80; p = 0.007) and with pharmacologic options as a barrier to prescribing intensive multifactorial interventions (OR = 0.32, 0.17-0.58; p < 0.001). Associations remained significant after adjusting for physician specialty, practice volume and frequency diagnosing or treating diabetes patients.ConclusionsSignificant gaps exist in diabetes-related knowledge and decision making among practicing physicians, as highlighted by clinical guideline use. The development of educational and training strategies to address these needs may ultimately improve outcomes for patients with diabetes and should be investigated in the future.Electronic supplementary materialThe online version of this article (doi:10.1186/1472-6920-14-186) contains supplementary material, which is available to authorized users.

show abstract

Effect of an educational intervention in primary care physicians on the compliance of indicators of good clinical practice in the treatment of type 2 diabetes mellitus [OBTEDIGA project]

Abstract: The identification of indicators with very low level of compliance and the implementation of a simple intervention in physicians to correct them is effective in improving the quality of care of diabetic patients.

Cited by 18 publications

References 39 publications

Guidelines on the prevention of foot ulcers in persons with diabetes (IWGDF 2019 update)

Guidelines on the prevention of foot ulcers in persons with diabetes (IWGDF 2019 update)

Treatment of modifiable risk factors for foot ulceration in persons with diabetes: a systematic review

The use of clinical guidelines highlights ongoing educational gaps in physicians’ knowledge and decision making related to diabetes

Contact Info

Product

Resources

About