Graham Woodward and associates1recently reported on poor adherence to the Canadian Diabetes Association (CDA) guidelines in the general population of eastern Ontario. A similar situation in British Columbia in 20012 led the Medical Services Commission and the British Columbia Medical Association to ask their joint Guidelines and Protocols Advisory Committee to suggest ways to enhance the management of diabetes. This effort led to the creation of the Kelowna Diabetes Program (KDP), through which a community medical laboratory assists people with diabetes (and their physicians) to achieve many of the goals recommended by the CDA.
The program involves an appointment and reminder system for laboratory testing that is based on the CDA guidelines and standing orders received from primary care physicians. In addition to regular laboratory reports, physicians receive periodic reports summarizing their patients' participation. Patients receive their own test results, along with explanatory comments and target goals for glycosylated hemoglobin (HbA1c), blood pressure, low-density lipoprotein cholesterol and risk ratio; they are also reminded of the importance of regular eye examinations. In addition to tests for variables typically associated with follow-up for diabetes (HbA1c, lipids, creatinine, urine microalbumin), patients undergo automated blood pressure measurements at each visit and have a yearly check of their glucometers for accuracy.
The project was conceived to assist busy physicians and their patients in managing diabetes in accordance with current CDA guidelines, but it was also anticipated that it could materially affect outcomes as measured by laboratory data initially and by clinical outcomes later.
Initiated in January 2002, the project has been enthusiastically accepted. As of Oct. 31, 2005, 118 (96%) of 123 local family physicians were participating in the program, and 5723 (76%) of an estimated 7500 people with diabetes in the Central Okanagan had been registered. Of these, 3937 (69% of 5723) were active participants; reasons for nonparticipation after registration include advanced disease, age and patient disinterest. An additional 951 (13% of 7500) people with diabetes have been identified and are now being registered.
The project relies on the administrative structure and information systems of the laboratory. A sophisticated computer system allows generation of special reports, letters and analyses of the growing database. A physician advisory group of 7 local family practitioners guides the evolution of the project.
After more than 4 years of operation, the project appears to have had a number of positive effects. The majority of people with diabetes in the Kelowna area have been identified, and KDP participants have had greater success than nonparticipants (and all people with diabetes in the province) in meeting the schedule of testing recommended by the CDA (Table 1). Participants have also had greater success than nonparticipants in achieving the recommended metabolic targets (Table 2). This is of particular significance in light of the reported association between achieving targets and the prevention of the complications of diabetes,3 which could yield major cost savings in the provision of health services to this segment of the population over the long term.
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