The Role of Physician and Practice Characteristics in the Quality of Diabetes Management in Primary Care: Systematic Review and Meta-analysis

Riordan, Fiona; McHugh, Sheena; O'Donovan, Clodagh; Mtshede, Mavis N; Kearney, Patricia M.

doi:10.1007/s11606-020-05676-7

Cited by 29 publications

(24 citation statements)

References 140 publications

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“…Older or more experienced doctors seem to follow guidelines to a lesser extent [30,[35][36][37], in accordance with our findings, but they may add other qualities such as psychosocial skills into diabetes care [38], not assessed in the present study.…”

Section: Comparison With Existing Literaturesupporting

confidence: 90%

“…A larger practice size reduced the GPs' risk of being in the lowest-performing quintile. Larger practices might facilitate more structured care, but the relation to quality of care is not clear, and other studies have found inconsistent associations of practice size and quality of diabetes care [30].…”

Section: Comparison With Existing Literaturementioning

confidence: 95%

“…A qualitative study also found that a large workload and time pressure was perceived as barriers to delivering appropriate diabetes care [34]. A systematic review, however, found an inconsistent relationship of workload and diabetes care [30].…”

Section: Comparison With Existing Literaturementioning

confidence: 99%

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Variation between general practitioners in type 2 diabetes processes of care

Nøkleby

Berg

Mdala

et al. 2021

Primary Care Diabetes

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Aims: To explore variation in general practitioners' (GPs') performance of six recommended procedures in type 2 diabetes patients <75 years without cardiovascular disease. Methods: Cross-sectional study of quality of diabetes care in Norway based on electronic health records from 2014. GPs (clustered in practices) were divided in quintiles based on a composite measure of performance of six processes of care. We fitted a multilevel partial ordinal regression model to identify GP factors associated with being in quintiles with better performance. Results: We identified 6015 type 2 diabetes patients from 275 GPs in 77 practices. The GPs performed on average 63.4% of the procedures; on average 46% in the poorest quintile to 81% in the best quintile with a larger range in individual GPs. After adjustments, use of a structured follow-up form was associated with GPs being in upper three quintiles (OR 12.4 (95% CI 2.37-65.1). Routines for reminders were associated with being in a better quintile . GPs' age >60 years and heavier workload were associated with poorer performance. Conclusion:We found large variations in GPs' performance of processes of care. Factors reflecting structure and workload were strongly associated with performance.

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Section: Comparison With Existing Literaturesupporting

confidence: 90%

Section: Comparison With Existing Literaturementioning

confidence: 95%

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Variation between general practitioners in type 2 diabetes processes of care

Nøkleby

Berg

Mdala

et al. 2021

Primary Care Diabetes

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“…The use of health informatics and electronic health records has been cited in the literature as a facilitator in the delivery of higher quality diabetes care in primary care. 30 This use of data analytics and knowledge was shared widely across the organisation and ensured that all team members had easily accessible to data and fostered a culture of data custodians among the staff. The foundation of this QI programme is based on effective communication through accessible means such as webinars and newsletters, and continuous efficient dissemination of healthcare data across all team members.…”

Section: Lessons and Limitationsmentioning

confidence: 99%

Improving the management of type 2 diabetes through large-scale general practice: the role of a data-driven and technology-enabled education programme

et al. 2021

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A quality improvement (QI) scheme was launched in 2017, covering a large group of 25 general practices working with a deprived registered population. The aim was to improve the measurable quality of care in a population where type 2 diabetes (T2D) care had previously proved challenging. A complex set of QI interventions were co-designed by a team of primary care clinicians and educationalists and managers. These interventions included organisation-wide goal setting, using a data-driven approach, ensuring staff engagement, implementing an educational programme for pharmacists, facilitating web-based QI learning at-scale and using methods which ensured sustainability. This programme was used to optimise the management of T2D through improving the eight care processes and three treatment targets which form part of the annual national diabetes audit for patients with T2D. With the implemented improvement interventions, there was significant improvement in all care processes and all treatment targets for patients with diabetes. Achievement of all the eight care processes improved by 46.0% (p<0.001) while achievement of all three treatment targets improved by 13.5% (p<0.001). The QI programme provides an example of a data-driven large-scale multicomponent intervention delivered in primary care in ethnically diverse and socially deprived areas.

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“…17 A meta-analysis of professional and practice-level factors associated with the quality of diabetes management in primary care identified doctor gender and age, doctor-level diabetes volume, practice deprivation and use of EHRs as significant determinants of quality, typically measured by a collection of individual indicators or a composite measure. 18 Furthermore, evidence from a systematic review and meta-analysis of quality improvement interventions for diabetes suggests that strategies that intervene on the entire system of chronic disease management are associated with the largest effects irrespective of baseline HbA1c. 15 Thus, to improve adherence to the frequency of HbA1c testing frequency, the problem needs to be understood in context, and solutions should incorporate professional and system-facing interventions as well as patient-facing interventions.…”

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confidence: 99%