A web-based diabetes intervention for physician: a cluster-randomized effectiveness trial

Abstract

Objective: To determine the effectiveness of a provider-based education and implementation intervention for improving diabetes control.

Design: Cluster-randomized trial with baseline and follow-up cross sections of diabetes patients in each participating physician's practice.

Setting: Eleven US Southeastern states, 2006-08.

Participants: Two hundred and five rural primary care physicians.

Intervention: Multi-component interactive intervention including Web-based continuing medical education, performance feedback and quality improvement tools. Primary Outcome Measures 'Acceptable control' [hemoglobin A1c ≤9%, blood pressure (BP) <140/90 mmHg, low-density lipoprotein cholesterol (LDL) <130 mg/dl] and 'optimal control' (A1c <7%, BP <130/80 mmHg, LDL <100 mg/dl).

Results: Of 364 physicians attempting to register, 205 were randomized to the intervention (n= 102) or control arms (n= 103). Baseline and follow-up data were provided by 95 physicians (2127 patients). The proportion of patients with A1c ≤9% was similar at baseline and follow-up in both the control [adjusted odds ratio (AOR): 0.94; 95% confidence interval (CI): 0.61, 1.47] and intervention arms [AOR: 1.16 (95% CI: 0.80, 1.69)]; BP <140/90 mmHg and LDL <130 mg/dl were also similar at both measurement points (P= 0.66, P= 0.46; respectively). We observed no significant effect on diabetes control attributable to the intervention for any of the primary outcome measures. Intervention physicians engaged with the Website over a median of 64.7 weeks [interquartile range (IQR): 45.4-81.8) for a median total of 37 min (IQR: 16-66).

Conclusions: A wide-reach, low-intensity, Web-based interactive multi-component intervention did not improve control of glucose, BP or lipids for patients with diabetes of physicians practicing in the rural Southeastern US.

Figure 1

Consolidated standards of reporting trials (CONSORT) diagram.

Figure 2

Main outcomes (top, middle panels). Proportions of patients with acceptable and optimal hemoglobin A1c, BP (BP, mmHg) and cholesterol (LDL, mg/dl) control for intervention (n= 48) or control (n= 47) physicians, at baseline (pre, n= 1182 patients) and follow-up (post, n= 945 patients). Secondary outcomes (bottom panel). Proportion assessed of hemoglobin A1c (past year), BP (last visit) and LDL (past 2 years). *P < 0.001, **P= 0.05.

Figure 3

Secondary outcomes. Hemoglobin A1c, systolic and diastolic BP (mmHg) and cholesterol (LDL, mg/dl) for patients in the control and intervention groups at baseline (pre) and follow-up (post) (values are means and 95% confidence intervals).