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Table 2 Overview of components of the Usual Quality Improvement Program (UQIP) and Advanced Quality Improvement Program (AQIP).

From: A cluster randomized trial to improve adherence to evidence-based guidelines on diabetes and reduce clinical inertia in primary care physicians in Belgium: study protocol [NTR 1369]

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

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Education of patients in practice (by flying educator)

 

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Education at patient's home (by flying educator)

 

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Counseling by health psychologist

 

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Structured educational materials from DCT

 

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Structured educational materials from community organizations

 

----

Group educational sessions for patients and family members

 

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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

 

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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

 

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Every three months: benchmarking feedback

Reminders

Clinical reminders at start and end of project

Every three months: Clinical reminders

 

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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

 

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Introduction of shared care protocol

Active encouragement by DCT and scientific team of PCPs to use shared care protocol

 

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Referral arrangements

Active encouragement by DCT and scientific team to adhere to referral arrangements

 

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Liaison activities by DCT towards in-hospital DCT in secondary care

 

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Involvement of independent pharmacists

Continuous quality improvement

Quality Assurance Team

Quality Assurance Team