1. TRINE LIGNELL GULDBERG14 MAY, 2009 DEPT. OF GENERAL PRACTICE SCHOOL OF PUBLIC HEALTH AARHUS UNIVERSITY 1 Development and evaluation of an electronic feedback system, a tool for optimizing diabetes care in general practice. T.L. Guldberg(1), P. Vedsted(2), J.K. Kristensen(1), V. Zoffmann(3), T. Lauritzen(1) Institute of Public Health, Aarhus University 1)Dept. of General Practice 2)Research Unit for General Practice,3) Steno Diabetes center

2. TRINE LIGNELL GULDBERG14 MAY, 2009 DEPT. OF GENERAL PRACTICE SCHOOL OF PUBLIC HEALTH AARHUS UNIVERSITY 2 Aim: To evaluate the effect of an electronic feedback system to GPs concerning their type 2-diabetes care in a randomized intervention design.

3. TRINE LIGNELL GULDBERG14 MAY, 2009 DEPT. OF GENERAL PRACTICE SCHOOL OF PUBLIC HEALTH AARHUS UNIVERSITY 3 Intervention: 90 general practitioners clinics have been randomised to either admission or no admission to an electronic feedback system. GPs cared for 5148 people with type 2-diabetes Intervention nested in Region Syddanmark and Region Midtjylland.

4. TRINE LIGNELL GULDBERG14 MAY, 2009 DEPT. OF GENERAL PRACTICE SCHOOL OF PUBLIC HEALTH AARHUS UNIVERSITY 4 Electronic feedback system: Distributed on CD Rom, Initially installed by visiting project worker. Updated quarterly. Launched in 2007 and ran for one year.

5. TRINE LIGNELL GULDBERG14 MAY, 2009 DEPT. OF GENERAL PRACTICE SCHOOL OF PUBLIC HEALTH AARHUS UNIVERSITY 5

6. TRINE LIGNELL GULDBERG14 MAY, 2009 DEPT. OF GENERAL PRACTICE SCHOOL OF PUBLIC HEALTH AARHUS UNIVERSITY 6

7. TRINE LIGNELL GULDBERG14 MAY, 2009 DEPT. OF GENERAL PRACTICE SCHOOL OF PUBLIC HEALTH AARHUS UNIVERSITY 7

8. TRINE LIGNELL GULDBERG14 MAY, 2009 DEPT. OF GENERAL PRACTICE SCHOOL OF PUBLIC HEALTH AARHUS UNIVERSITY 8 Evaluation: Quantitative evaluation on register data and log data Qualitative evaluation on interview data with intervention GPs

9. TRINE LIGNELL GULDBERG14 MAY, 2009 DEPT. OF GENERAL PRACTICE SCHOOL OF PUBLIC HEALTH AARHUS UNIVERSITY 9 Primary output: Usage of the electronic feedback system Used at overall level? Used at individual patient level? Impact of system in intervention clinics

10. TRINE LIGNELL GULDBERG14 MAY, 2009 DEPT. OF GENERAL PRACTICE SCHOOL OF PUBLIC HEALTH AARHUS UNIVERSITY 10 Initial Log data Interview data Intermediate Interview data Long term Register data: Data on laboratory tests Data on medicinal use Data on diabetes-related eye examinations Interview data Outcome

11. TRINE LIGNELL GULDBERG14 MAY, 2009 DEPT. OF GENERAL PRACTICE SCHOOL OF PUBLIC HEALTH AARHUS UNIVERSITY 11 Initial GPs used the sortable lists to get an overview of the patient population. Interview data Intermediate Interview data Long term Register data: Data on laboratory tests Data on medicinal use Data on diabetes-related eye examinations Interview data Outcome

12. TRINE LIGNELL GULDBERG14 MAY, 2009 DEPT. OF GENERAL PRACTICE SCHOOL OF PUBLIC HEALTH AARHUS UNIVERSITY 12 Initial GPs used the sortable lists to get an overview of the patient population. The lists generated attention to problem areas in the diabetes care. Intermediate Interview data Long term Register data: Data on laboratory tests Data on medicinal use Data on diabetes-related eye examinations Interview data Outcome

13. TRINE LIGNELL GULDBERG14 MAY, 2009 DEPT. OF GENERAL PRACTICE SCHOOL OF PUBLIC HEALTH AARHUS UNIVERSITY 13 Initial GPs used the sortable lists to get an overview of the patient population. The lists generated attention to problem areas in the diabetes care. Intermediate Increased attention led to : Organisational changes in two of four GP clinics Additional education of practice nurses Allocation of diabetes care to practice nurses, Long term Register data: Data on laboratory tests Data on medicinal use Data on diabetes-related eye examinations Interview data Outcome

14. TRINE LIGNELL GULDBERG14 MAY, 2009 DEPT. OF GENERAL PRACTICE SCHOOL OF PUBLIC HEALTH AARHUS UNIVERSITY 14 Initial GPs used the sortable lists to get an overview of the patient population. The lists generated attention to problem areas in the diabetes care. Intermediate Increased attention led to : Organisational changes in two of four GP clinics Additional education of practice nurses Allocation of diabetes care to practice nurses, Long term Intervention GPs have more: Cholesterol controls (p=0,036) Patient eye examinations (p=0,005) Use of statins (p=0,016), metformin (p=0,004) and ACE inhibitors (p=0,008) Interview data Outcome

15. TRINE LIGNELL GULDBERG14 MAY, 2009 DEPT. OF GENERAL PRACTICE SCHOOL OF PUBLIC HEALTH AARHUS UNIVERSITY 15 Initial GPs used the sortable lists to get an overview of the patient population. The lists generated attention to problem areas in the diabetes care. Intermediate Increased attention led to : Organisational changes in two of four GP clinics Additional education of practice nurses Allocation of diabetes care to practice nurses, Long term Intervention GPs have more: Cholesterol controls (p=0,036) Patient eye examinations (p=0,005) Use of statins (p=0,016), metformin (p=0,004) and ACE inhibitors (p=0,008) GPs felt liberated by allocating diabetes care to nurses, GPs spend more time on other patient groups. Outcome

16. TRINE LIGNELL GULDBERG14 MAY, 2009 DEPT. OF GENERAL PRACTICE SCHOOL OF PUBLIC HEALTH AARHUS UNIVERSITY 16 Problems discovered: No usage on individual patient level due to: No real time data Practice in-house IT systems superior in data and familiar to use.

17. TRINE LIGNELL GULDBERG14 MAY, 2009 DEPT. OF GENERAL PRACTICE SCHOOL OF PUBLIC HEALTH AARHUS UNIVERSITY 17 Perspectives: An electronic feedback system containing sortable lists generated new insight into the quality of diabetes care in GP clinics New attention to quality of diabetes care led to organisational changes in GP clinics, allocating diabetes care to practice nurses. An electronic feedback system led to better quality of care for people with Type 2-Diabetes in general practice.

18. TRINE LIGNELL GULDBERG14 MAY, 2009 DEPT. OF GENERAL PRACTICE SCHOOL OF PUBLIC HEALTH AARHUS UNIVERSITY 18 Thank you.