Action plans and guideline distribution and training also affected monitoring rates, although to a lesser degree.
Guideline distribution and training increased the likelihood of glycemic monitoring; the odds ratio was 1.46 (p < 0.03).
Varying effects of action plans and guideline distribution and training are shown in the literature [ 14, 16, 17, 35- 38].
The effects of action plans and guideline distribution and training were significant at a level well below that of provider alerts.
Information was obtained from the National Health Service County Registry for the dates of October 2000 to October 2002 (the year before and the year after the October 2001 guideline distribution).
From October 2000 2002 (the year before and the year after the October 2001 guideline distribution), referrals to the 2 gynecological outpatient clinics, 3 surgical outpatient clinics, and 1 UI outpatient clinic in Frederiksborg County fluctuated during the 2-year observation period.
Weaker associations were found between action plans and glycemic monitoring (odds ratio = 1.44; p < 0.03) and between guideline distribution and training and lipid monitoring (odds ratio = 1.46; p < 0.03).
For the program evaluation, ten control sites were selected where no PALM PLUS training or guideline distribution had occurred at the time of data collection; and eleven intervention sites were selected where training in PALM PLUS had occurred.
Of fifteen diabetes care management practices, our data indicate that high performance is most associated with provider alerts and more weakly associated with action plans and with guideline distribution and training.
The problem is not with charitable donors, who are simply following the rules provided for them, but rather with laws that fail to provide adequate guidelines for distribution.
Open image in new window Fig. 6 Guidelines survey: distribution.
