Cluster randomised trial on the effectiveness of a computerised prompt to refer (back) patients with type 2 diabetes

Maaike C.M. Ronda; Lioe Ting Dijkhorst-Oei; Rimke C. Vos; Paul Westers; Guy E.H.M. Rutten

doi:10.1371/journal.pone.0207653

Cluster randomised trial on the effectiveness of a computerised prompt to refer (back) patients with type 2 diabetes

Maaike C.M. Ronda^*, Lioe Ting Dijkhorst-Oei, Rimke C. Vos, Paul Westers, Guy E.H.M. Rutten

^*Corresponding author for this work

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Abstract

Aims Information and communications technology (ICT) could support care organisations to cope with the increasing number of patients with diabetes mellitus. We aimed to aid diabetes care providers in allocating patients to the preferred treatment setting (hospital outpatient clinic or primary care practice), by using the Electronic Medical Record (EMR). Methods A cluster randomised controlled trial. Physicians in primary and secondary care practices of the intervention group received an advisory message in the EMR during diabetes consultations if patients were treated in the ‘incorrect’ setting according to national management guidelines. Primary outcome: the proportion of patients that shifted to the correct treatment setting at one year follow-up. Results 47 (38 primary care and 9 internist) practices and 2778 patients were included. At baseline, 1197 (43.1%) patients were in the correct treatment setting (intervention 599; control 598). Advice most often (68.4%) regarded a consultation with the internist. After one year 12.4% of the patients in the intervention and 10.6% in the control group (p = 0.30) had shifted to the correct setting. Main reasons for not following advice were: 1. physician’s preference to consider other treatment options; 2. patients’ preferences. Conclusions We could not find evidence that using the EMR to send consultation-linked advice to physicians resulted in a shift in patients. Physicians will not follow the advice, at least partly due to patients’ preferences.

Original language	English
Article number	e0207653
Pages (from-to)	e0207653
Journal	PLoS ONE
Volume	13
Issue number	12
DOIs	https://doi.org/10.1371/journal.pone.0207653
Publication status	Published - 1 Dec 2018

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@article{1ffa7357470a4613ae3436e352fc6592,

title = "Cluster randomised trial on the effectiveness of a computerised prompt to refer (back) patients with type 2 diabetes",

abstract = "Aims Information and communications technology (ICT) could support care organisations to cope with the increasing number of patients with diabetes mellitus. We aimed to aid diabetes care providers in allocating patients to the preferred treatment setting (hospital outpatient clinic or primary care practice), by using the Electronic Medical Record (EMR). Methods A cluster randomised controlled trial. Physicians in primary and secondary care practices of the intervention group received an advisory message in the EMR during diabetes consultations if patients were treated in the {\textquoteleft}incorrect{\textquoteright} setting according to national management guidelines. Primary outcome: the proportion of patients that shifted to the correct treatment setting at one year follow-up. Results 47 (38 primary care and 9 internist) practices and 2778 patients were included. At baseline, 1197 (43.1%) patients were in the correct treatment setting (intervention 599; control 598). Advice most often (68.4%) regarded a consultation with the internist. After one year 12.4% of the patients in the intervention and 10.6% in the control group (p = 0.30) had shifted to the correct setting. Main reasons for not following advice were: 1. physician{\textquoteright}s preference to consider other treatment options; 2. patients{\textquoteright} preferences. Conclusions We could not find evidence that using the EMR to send consultation-linked advice to physicians resulted in a shift in patients. Physicians will not follow the advice, at least partly due to patients{\textquoteright} preferences.",

author = "Ronda, {Maaike C.M.} and Dijkhorst-Oei, {Lioe Ting} and Vos, {Rimke C.} and Paul Westers and Rutten, {Guy E.H.M.}",

note = "Funding Information: This study is funded by Diamuraal and the Julius Center for Health Sciences and Primary Care Research, University Medical Center Utrecht. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. GR and LT-DO initiated the study. GR, LT-DO and MR participated in designing the study. PW, RV and MR did the statistical analysis and all authors participated in the interpretation of data. This paper was drafted by MR and critically revised by all authors. All authors read and approved the final manuscript. We would like to acknowledge the team of Portavita for building the automatic marker to our alerts. Publisher Copyright: {\textcopyright} 2018 Ronda et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.",

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doi = "10.1371/journal.pone.0207653",

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T1 - Cluster randomised trial on the effectiveness of a computerised prompt to refer (back) patients with type 2 diabetes

AU - Ronda, Maaike C.M.

AU - Dijkhorst-Oei, Lioe Ting

AU - Vos, Rimke C.

AU - Westers, Paul

AU - Rutten, Guy E.H.M.

N1 - Funding Information: This study is funded by Diamuraal and the Julius Center for Health Sciences and Primary Care Research, University Medical Center Utrecht. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. GR and LT-DO initiated the study. GR, LT-DO and MR participated in designing the study. PW, RV and MR did the statistical analysis and all authors participated in the interpretation of data. This paper was drafted by MR and critically revised by all authors. All authors read and approved the final manuscript. We would like to acknowledge the team of Portavita for building the automatic marker to our alerts. Publisher Copyright: © 2018 Ronda et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

PY - 2018/12/1

Y1 - 2018/12/1

N2 - Aims Information and communications technology (ICT) could support care organisations to cope with the increasing number of patients with diabetes mellitus. We aimed to aid diabetes care providers in allocating patients to the preferred treatment setting (hospital outpatient clinic or primary care practice), by using the Electronic Medical Record (EMR). Methods A cluster randomised controlled trial. Physicians in primary and secondary care practices of the intervention group received an advisory message in the EMR during diabetes consultations if patients were treated in the ‘incorrect’ setting according to national management guidelines. Primary outcome: the proportion of patients that shifted to the correct treatment setting at one year follow-up. Results 47 (38 primary care and 9 internist) practices and 2778 patients were included. At baseline, 1197 (43.1%) patients were in the correct treatment setting (intervention 599; control 598). Advice most often (68.4%) regarded a consultation with the internist. After one year 12.4% of the patients in the intervention and 10.6% in the control group (p = 0.30) had shifted to the correct setting. Main reasons for not following advice were: 1. physician’s preference to consider other treatment options; 2. patients’ preferences. Conclusions We could not find evidence that using the EMR to send consultation-linked advice to physicians resulted in a shift in patients. Physicians will not follow the advice, at least partly due to patients’ preferences.

AB - Aims Information and communications technology (ICT) could support care organisations to cope with the increasing number of patients with diabetes mellitus. We aimed to aid diabetes care providers in allocating patients to the preferred treatment setting (hospital outpatient clinic or primary care practice), by using the Electronic Medical Record (EMR). Methods A cluster randomised controlled trial. Physicians in primary and secondary care practices of the intervention group received an advisory message in the EMR during diabetes consultations if patients were treated in the ‘incorrect’ setting according to national management guidelines. Primary outcome: the proportion of patients that shifted to the correct treatment setting at one year follow-up. Results 47 (38 primary care and 9 internist) practices and 2778 patients were included. At baseline, 1197 (43.1%) patients were in the correct treatment setting (intervention 599; control 598). Advice most often (68.4%) regarded a consultation with the internist. After one year 12.4% of the patients in the intervention and 10.6% in the control group (p = 0.30) had shifted to the correct setting. Main reasons for not following advice were: 1. physician’s preference to consider other treatment options; 2. patients’ preferences. Conclusions We could not find evidence that using the EMR to send consultation-linked advice to physicians resulted in a shift in patients. Physicians will not follow the advice, at least partly due to patients’ preferences.

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Cluster randomised trial on the effectiveness of a computerised prompt to refer (back) patients with type 2 diabetes

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