Patient | ||
---|---|---|
Lack of adhere to treatment regimen and clinical inertia related to: e.g. Limited motivation or resistance to adopting lifestyles that support optimal disease care. | ||
 | Usual Quality Improvement Program (UQIP) | Advanced Quality Improvement Program (AQIP) |
Patient education | Medical assessments and education upon referral of the PCPs by diabetologist or DCT | Medical assessments and education upon referral of the PCPs by diabetologist or DCT (DCT) |
 | = internist, nurse educator, dietician and ophthalmologist | = internist, nurse educator, flying educator, dietician, ophthalmologist and health psychologist |
Promotion of self-management | ---- | Education of patients in practice (by flying educator) |
 | ---- | Education at patient's home (by flying educator) |
 | ---- | Counseling by health psychologist |
 | ---- | Structured educational materials from DCT |
 | ---- | Structured educational materials from community organizations |
 | ---- | Group educational sessions for patients and family members |
 | ---- | Free access to blood monitoring tools for self-management |
Professional | ||
Lack of adherence to guidelines and clinical inertia related to: e.g . Overestimation of care actually delivered, a failure to identify and manage comorbid conditions, unawareness or disagreement with evidence-based goals of care and 'soft reasons' to avoid intensification of therapy. | ||
 | Usual Quality Improvement Program (UQIP) | Advanced Quality Improvement Program (AQIP) |
Clinician education | Distribution of treatment protocol | Distribution of treatment protocol |
 | Two post-graduate educational sessions | Four post-graduate educational sessions provided by diabetologist (opinion leader): |
 | Evidence based guidelines | Evidence-based guidelines and principles of shared care |
 | The use of insulin | The use of insulin |
 |  | Patient-centered counseling |
 |  | Peer review |
 | Standard educational materials | Extended educational materials |
 | ---- | Inviting PCPs during DCT meetings to discuss patient cases |
 | ---- | Providing structured communication forms to PCPs by DCT |
 | ---- | Distribution of shared care protocol + referral indication |
Feedback | At start and end of project: summary of clinical performance | Every 3 months: summaries of clinical performance |
 | ---- | Every three months: benchmarking feedback |
Reminders | Clinical reminders at start and end of project | Every three months: Clinical reminders |
 | ---- | Every three months: Shared care reminders |
Organisational | ||
Lack of office system support and organizational aspects of care related to clinical inertia: e.g. Lack of decision support and a team approach to care. | ||
 | Usual Quality Improvement Program (UQIP) | Advanced Quality Improvement Program (AQIP) |
Team changes | DCT operating close to regular care | Active instalment of DCT operating under supervision of a diabetologist from a University Hospital |
 |  | Diabetes Program manager providing logistic support to PCPs |
 | ---- | Introduction of shared care protocol Active encouragement by DCT and scientific team of PCPs to use shared care protocol |
 | ---- | Referral arrangements Active encouragement by DCT and scientific team to adhere to referral arrangements |
 | ---- | Liaison activities by DCT towards in-hospital DCT in secondary care |
 | ---- | Involvement of independent pharmacists |
Continuous quality improvement | Quality Assurance Team | Quality Assurance Team |