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document
Multifaceted support to improve clinical decision making in diabetes care : a randomized controlled trial in general practice . AIMS To evaluate the effectiveness of a multifaceted intervention to improve the clinical decision making of general practitioners ( GPs ) for patients with diabetes . To identify practice characteristics which predict success . METHODS Cluster randomized controlled trial with 124 practices and 185 GPs in The Netherlands . The intervention group received feedback reports and support from a facilitator ; the control group received no special attention . Outcome measures were the compliance rates with evidence-based recommendations pertaining to discussion of body weight control , discussion of problems with medication , blood pressure measurement , foot examination , eye examination , initiating anti-diabetic medication or increasing the dosage in cases of uncontrolled blood glucose , and scheduling a follow-up appointment . RESULTS The GPs reported on their clinical decision making in 1410 consultations with Type 2 diabetic patients at baseline and 1449 consultations after the intervention period . The intervention resulted in statistically significant improvement for two of the seven outcome measures : foot examination ( odds ratio 1.68 ; 95 % confidence interval 1.19-2.39 ) and eye examination ( 1.52 ; 1.07-2.16 ) . Discussion of problems with medication showed a near significant trend towards increased benefit for the intervention group ( 1.52 ; 0.99-2.32 ) . Practice characteristics were not found to be related to the success of the intervention . CONCLUSIONS Feedback reports with support from facilitators appear to increase rates of foot examination and eye examination in general practice . Alternative interventions should be explored to improve the pursuit of metabolic control by GPs .
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Intervention_Educational
Multifaceted support
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Intervention_Educational
multifaceted intervention
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Intervention_Educational
feedback reports and support from a facilitator
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Intervention_Control
no special attention
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Participant_Condition
general practitioners ( GPs ) for patients with diabetes
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Participant_Sample-size
124 practices
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Participant_Sample-size
185
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Participant_Sample-size
1410
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Participant_Condition
Type 2 diabetic patients