Diabetes is a common and serious chronic disease. However, there is a large gap between the level of care that people should receive (based on research and guidelines) and the level of care they actually receive. With the release of their 2008 Clinical Practice Guidelines, the Canadian Diabetes Association has a strategy to improve heart disease screening and treatment for people with diabetes. This study will evaluate whether the strategy works. The focus of the strategy was to give all family physicians in Canada a Toolkit in June 2009 to help them delivery better care for their diabetic patients. In Ontario, only half of doctors received this Toolkit. We will compare the quality of care received by diabetic patients whose doctors received this Toolkit versus those who doctors did not.
A cardiovascular disease Toolkit was developed by the Canadian Diabetes Association and mailed to family physician with the Spring/Summer 2009 edition of the newsletter, Canadian Diabetes. The Toolkit was packaged in a brightly-coloured box with Canadian Diabetes Association branding, and contained: 1) an introductory letter from the Chair of the practice guidelines' Dissemination and Implementation Committee; 2) an eight page summary of selected sections of the practice guidelines targeted towards primary care physicians; 3) a four page synopsis of the key guideline elements pertaining to cardiovascular disease risk; 4) a small double-sided laminated card with a simplified algorithm for cardiovascular risk assessment, vascular protection strategies and screening for cardiovascular disease; and 5) a pad of tear-off sheets for patients with a cardiovascular risk self-assessment tool and a list of recommended risk reduction strategies.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
HEALTH_SERVICES_RESEARCH
Masking
SINGLE
Enrollment
1,592
Cardiovascular Disease Toolkit mailed by the Canadian Diabetes Association to family physicians, accompanying the Spring/Summer 2009 edition of the quarterly newsletter, Canadian Diabetes. (Mailed in June 2009.) The Toolkit includes a summary of selected sections of the practice guidelines targeted towards primary care physicians; a synopsis of the key messages pertaining to cardiovascular disease risk; a laminated card with a simplified algorithm for cardiovascular risk assessment and treatment; and a pad of tear-off sheets for patients with a cardiovascular risk self-assessment tool.
The Spring/Summer 2009 issue of the quarterly newsletter, Canadian Diabetes, mailed on its own. The Cardiovascular Toolkit was mailed to Control arm physicians with the May 2010 issue of the newsletter.
Institute for Clinical Evaluative Sciences
Toronto, Ontario, Canada
Patient is receiving a statin
Time frame: July 2009 to April 2010
Patient is receiving an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker
Time frame: July 2009 to April 2010
A1c level
Time frame: Last observation between July 2009 and April 2010
Blood pressure level
Time frame: Last observation between July 2009 and April 2010
LDL-cholesterol level
Time frame: Last observation between July 2009 and April 2010
Total- to HDL-cholesterol ratio
Time frame: Last observation between July 2009 and April 2010
Body mass index
Time frame: Last observation between July 2009 and April 2010
Waist circumference
Time frame: Last observation between July 2009 and April 2010
Change in treatment recommended following an A1c level above 0.070
Time frame: At the next patient visit after the abnormal measurement
Change in treatment recommended following a systolic blood pressure above 130 or a diastolic blood pressure above 80
Time frame: At the patient visit of the abnormal measurement
Change in treatment recommended following an LDL-cholesterol level above 2.0 mmol/L
Time frame: At the next patient visit after the abnormal measurement
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