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At least 1,243 records · Page 69Linked to original sources

PubMed2005

Alcohol screening and brief intervention in primary care settings: implementation models and predictors.

OBJECTIVE: This study compared two different implementation strategies for Cutting Back, a primary care alcohol screening and brief intervention (SBI) program for hazardous and harmful drinkers. It also identified organizational factors contributing to the success or failure of SBI implementation. METHOD: Cutting Back was implemented in 10 primary care practices associated with managed care organizations (MCOs) in five states, through a system of planning, training, technical assistance and clinic feedback. Clinics were randomly assigned to one of two brief intervention systems: In the P Model, medical providers were responsible for delivering interventions, whereas in the S Model mid-level professionals (usually nurses) acted as the clinic specialists to provide that service. Data were collected to measure the performance of screening and delivery of interventions in each clinic. RESULTS: The S Model screened a higher percentage of patients than did the P Model during the best month of program operation (50% vs 44%) and over all months of operation (24% vs 19%). Of those patients who screened positive, more patients in the S condition received an intervention than in the P condition (73.1% vs 57.1%), but there was a considerable range of performance among the five sites within each condition. Results at the clinic level were mixed, with some MCOs performing alcohol SBI significantly better with the S model and others doing better with the P model. The ability of clinics to conduct SBI was significantly correlated with both provider characteristics and organizational factors (e.g., prior SBI experience, MCO stability, number of clinicians trained and the quality of the MCO coordinator's work). Lack of provider time, staff turnover and competing priorities correlated negatively with SBI performance. CONCLUSIONS: The extent to which a given delivery model is likely to work best within an MCO depends on complex provider and organizational characteristics.

Adolescent↗

PubMed2005

Questionnaire survey and environmental measurements that led to smooth implementation of smoking control measures in workplaces.

In order to promote smoking countermeasures in a manufacturing plant, we conducted a questionnaire survey about smoking control measures in workplaces. Twenty nine point five percent of the subjects responded that they were exposed to passive smoking where they worked and that the most common source of passive smoking in the workplace and rest areas was environmental tobacco smoke (ETS) leaking from smoking areas. For smoking control measures, 27.8% of employees preferred a total ban on smoking in the building while 55.2% preferred measures to prevent ETS leakage from smoking areas. Regardless of whether they were smokers or not, 99.2% of respondents believed that passive smoking countermeasures in the workplace were necessary and 88.9% of smokers responded that banning smoking in the building was unavoidable. Based on these results, a total ban on smoking in the building was implemented in those workplaces where it was feasible to do so, smoking areas in the remaining workplaces were upgraded to prevent ETS infiltration, and the effects were evaluated by real-time monitoring of the concentration of suspended particle matter. The questionnaire survey results showed that 79.9% of smokers were interested in smoking cessation, that awareness of the adverse health effects of smoking on the smoker and surrounding non-smokers and the nuisance it caused was significantly lower among smokers compared to non-smokers (p<0.01), and that 65.5% of non-smokers believed that smoking was beneficial to the mental health of smokers, despite the fact that they had no experience of smoking themselves. Reporting these results to the Safety and Health Committee was found to be useful both in ensuring thorough segregation of smoking areas and in supporting smoking cessation programs in places where no previous action had been taken because smoking was viewed as a matter of personal choice. We also believe that provision of accurate information tailored to actual smoking conditions in the workplace is useful in effectively implementing anti-smoking campaigns on the adverse effects of smoking and smoking cessation programs. The implementation of a questionnaire survey and environmental measurements that lead to countermeasures was shown to be effective in establishing designated smoking areas and educational programs for smoking cessation.

Air Pollution, Indoor↗

PubMed2004

Implementing the American Academy of Pediatrics attention-deficit/hyperactivity disorder diagnostic guidelines in primary care settings.

OBJECTIVES: To evaluate the feasibility of the San Diego Attention-Deficit/Hyperactivity Disorder Project (SANDAP) protocol, a pediatric community-initiated quality improvement effort to foster implementation of the American Academy of Pediatrics (AAP) attention-deficit/hyperactivity disorder (ADHD) diagnostic guidelines, and to identify any additional barriers to providing evidence-based ADHD evaluative care. METHODS: Seven research-naïve primary care offices in the San Diego area were recruited to participate. Offices were trained in the SANDAP protocol, which included 1) physician education, 2) a standardized assessment packet for parents and teachers, 3) an ADHD coordinator to assist in collection and collation of the assessment packet components, 4) educational materials for clinicians, parents, and teachers, in the form of handouts and a website, and 5) flowcharts delineating local paths for referral to medical subspecialists, mental health practitioners, and school-based professionals. The assessment packet included the parent and teacher versions of the Vanderbilt ADHD Diagnostic Rating Scales. In this study, we chose a conservative interpretation of the AAP ADHD guidelines for diagnosing ADHD, requiring that a child met criteria for ADHD on both the parent and teacher rating scales. A mixed-method analytic strategy was used to address feasibility and barriers, including quantitative surveys with parents and teachers and qualitative debriefing sessions conducted an average of 3 times per year with pediatricians and office staff members. RESULTS: Between December 2000 and April 2003, 159 children were consecutively enrolled for evaluation of school and/or behavioral problems. Clinically, only 44% of the children met criteria for ADHD on both the parent and teacher scales, and 73.5% of those children were categorized as having the combined subtype. More than 40% of the subjects demonstrated discrepant results on the Vanderbilt scales, with only the parent or teacher endorsing sufficient symptoms to meet the criteria of the Diagnostic and Statistical Manual of Mental Disorders, 4th ed. Other mental health and learning problems were common in the sample; 58.5% of subjects met screening criteria for oppositional defiant disorder/conduct disorder, 32.7% met screening criteria for anxiety/depression, and approximately one-third had an active individualized education program in place or had received an individualized education program in the past. On evaluation, the SANDAP protocol was acceptable and feasible for all stakeholders. However, additional barriers to implementing the AAP ADHD guidelines were identified, including 1) limited information in the guidelines regarding the use of specific ADHD rating scales, the evaluation and treatment of children with discrepant and/or negative results, and the indications for psychologic evaluation of learning problems, 2) families' need for education regarding ADHD and support, 3) characteristics of physical health and mental health plans that limited care for children with ADHD, and 4) limited knowledge and use of potential community resources. CONCLUSIONS: Our results indicate that children presenting for evaluation of possible ADHD in primary care offices have complex clinical characteristics. Providers need mechanisms for implementing the ADHD diagnostic guidelines that address the physician education and delivery system design aspects of care that were developed in the SANDAP protocol. Additional barriers were also identified. Careful attention to these factors will be necessary to ensure the sustained provision of quality care for children with ADHD in primary care settings.

Attention Deficit Disorder with Hyperactivity↗

PubMed2006

Implementation and case-study results of potentially better practices to improve the discharge process in the neonatal intensive care unit.

OBJECTIVE: The objective of this study was to implement potentially better practices for discharge planning in the NICU. METHODS: Each participating hospital completed a self-assessment tool on discharge planning and a staff satisfaction survey. Parent satisfaction data were obtained from an Internet-based survey. Many projects regarding discharge planning were completed at each participating center. A major emphasis was the development of transition points to span discharge planning over the entire hospitalization. Results of compliance with tasks or processes that were identified by the transition points and results of staff and parent satisfaction surveys were monitored over time. RESULTS: The implementation of the transition points at each center demonstrated an improvement in the completion of discharge tasks within the recommended time frame. Combined results of all centers demonstrated a moderate improvement in compliance with transition points from baseline to final measurement in the following areas: unit orientation (56%-81%), identification of a parent feeding plan (74%-92%), completion of cardiopulmonary resuscitation training (55%-72%), and car seat education (42%-63%). Staff survey results showed improvement from baseline to final measurement in the following areas: staff satisfaction with the discharge process (32%-50%), clear documentation of the discharge plan (26%-40%), and clarity of team members' roles in the discharge process (24%-44%). A resource kit on discharge planning was developed for staff and included a section with parent education material. An Internet-based parent satisfaction survey was implemented successfully. CONCLUSIONS: All centers that participated in the collaborative made significant strides in the discharge planning process. Overall, parent satisfaction with discharge planning was high, and improvements were noted in staff satisfaction and availability of resource material.

Attitude of Health Personnel↗

PubMed2003

Two-dimensional gap analysis: a tool for efficient conservation planning and biodiversity policy implementation.

The maintenance of biodiversity by securing representative and well-connected habitat networks in managed landscapes requires a wise combination of protection, management, and restoration of habitats at several scales. We suggest that the integration of natural and social sciences in the form of "Two-dimensional gap analysis" is an efficient tool for the implementation of biodiversity policies. The tool links biologically relevant "horizontal" ecological issues with "vertical" issues related to institutions and other societal issues. Using forest biodiversity as an example, we illustrate how one can combine ecological and institutional aspects of biodiversity conservation, thus facilitating environmentally sustainable regional development. In particular, we use regional gap analysis for identification of focal forest types, habitat modelling for ascertaining the functional connectivity of "green infrastructures", as tools for the horizontal gap analysis. For the vertical dimension we suggest how the social sciences can be used for assessing the success in the implementation of biodiversity policies in real landscapes by identifying institutional obstacles while implementing policies. We argue that this interdisciplinary approach could be applied in a whole range of other environments including other terrestrial biota and aquatic ecosystems where functional habitat connectivity, nonlinear response to habitat loss and a multitude of economic and social interests co-occur in the same landscape.

Conservation of Natural Resources↗

PubMed2006

[The nursing diagnosis implementation process at the University Hospital of the University of São Paulo].

More than two decades ago the Nursing Department at the University Hospital of the University of São Paulo implemented the care model called Nursing Care System (NCS), which is comprised of three phases: Background, Evaluation and Nursing Prescription. Since then, it is being developed by the Nursing Department nurses as a guiding instrument for care, teaching and research. Having in mind the automation of the NCS, the nurses began to discuss the need for changes that could speed up the work process with the proposal of implementation of the Nursing Diagnosis as another step of the NCS and with the review of nursing action/interventions. In order to do so, the adoption of a standardized system of the care process language became essential so as to make possible data capture, grouping and classification for analysis and their transformation into information. The present study aims at sharing with other nurses this experience on the implementation process of the Nursing Diagnosis as a second step of the NCS.

Brazil↗

PubMedDate not supplied

[Methodology for the implementation of e-Health services for chronic patient monitoring and control].

A methodology is presented for a smooth, orderly implementation of specific e-Health services for monitoring chronic patients outside of the hospital setting. Identified as a stage-gate model for the management of the overall implementation process, this methodology is presented formally structured into three steps: a) exploratory examination (pilot project stage); 2) in-depth evaluation (clinical trial stage); and 3) deployment (guided use stage). In the first stage, controlled by the R+D team, the predominant criiteria are the functionality and usability of the technologies involved. In the second stage, controlled by an associated Health Technology Evaluation Agency, the predominant criterion is the scientific aspect related to the results obtained in the clinical testing. The third stage is controlled through decisions made by the health administrations as to the implementation of new technologies and the financing thereof. A description is provided as to the requirements of the technological platform designed to serve its the medium for the projects and tests from stage 1 and 2. As an example of what is done in stage 2, a description is given of a trial related to hypertension.

Chronic Disease↗

PubMed2006

An examination of cross-cultural systems implementing evidence-based assessment and intervention approaches.

Implementation of evidence-based assessment and intervention approaches for youth with behavioral and/or emotional problems is rising to recognition worldwide. Feasibility research is critical to examine what characteristics of systems allow for success or barriers to the implementation of evidence-based practices into real-world settings, especially when working cross-culturally. This paper briefly reviews the experience of 4 international sites to understand how the overall structure and specific site variables directed the implementation of the World Health Organization and the World Psychiatry Association project. Discussion includes a thematic summary of the successes and challenges experienced by the sites, and future directions of feasibility studies.

Adolescent↗

PubMed1999

Clinical practice guidelines in end-stage renal disease: a strategy for implementation.

Clinical practice guidelines (CPGs) for end-stage renal failure (ESRD) were recently published, and represent a comprehensive review of available literature and the considered judgment of experts in ESRD. To prioritize and implement these guidelines, the evidence underlying each guideline should be ranked and the attributes of each should be defined. Strategies to improve practice patterns should be tested. Focused information for each high priority guideline should be disseminated, including a synopsis and assessment of the underlying evidence, the evidence model used to develop that guideline, and suggested strategies for CPG implementation. Clinical performance measures should be developed and used to measure current practice, and the success of changing practice patterns on clinical outcomes. Individual practitioners and dialysis facilities should be encouraged to utilize continuous quality improvement techniques to put the guidelines into effect. Local implementation should proceed at the same time as a national project to convert high priority CPGs into clinical performance measures proceeds. Patients and patient care organizations should participate in this process, and professional organizations must make a strong commitment to educate clinicians in the methodology of CPG and performance measure development and the techniques of continuous quality improvement. Health care regulators should understand that CPGs are not standards, but are statements that assist practitioners and patients in making decisions.

Diffusion of Innovation↗

PubMed1995

Increasing complex social behaviors in children with autism: effects of peer-implemented pivotal response training.

Two children with autism were taught to engage in a variety of complex social behaviors using peer-implemented pivotal response training (PRT), a set of procedures designed to increase motivation and promote generalization. Typical peers were taught to implement PRT strategies by modeling, role playing, and didactic instruction. After training, peers implemented the procedures in the absence of direct supervision in a classroom environment. After the intervention, both children with autism maintained prolonged interactions with the peer, initiated play and conversations, and increased engagement in language and joint attention behaviors. In addition, teachers reported positive changes in social behavior, with the largest increases in peer-preferred social behavior. Further, these effects showed generality and maintenance. Implications of these findings are discussed.

Autistic Disorder↗

PubMed2005

Effects of immediate performance feedback on implementation of behavior support plans.

Research has focused on increasing the treatment integrity of school-based interventions by utilizing performance feedback. The purpose of this study was to extend this literature by increasing special education teachers' treatment integrity for implementing antecedent and consequence procedures in an ongoing behavior support plan. A multiple baseline across teacher-student dyads (for two classrooms) design was used to evaluate the effects of performance feedback on the percentage of antecedent and consequence components implemented correctly during 1-hr observation sessions. Performance feedback was provided every other week for 8 to 22 weeks after a stable or decreasing trend in the percentage of antecedent or consequence components implemented correctly. Results suggested that performance feedback increased the treatment integrity of antecedent components for 4 of 5 teachers and consequence components for all 5 teachers. These results were maintained following feedback for all teachers across antecedent and consequence components. Teachers rated performance feedback favorably with respect to the purpose, procedures, and outcome, as indicated by a social validity rating measure.

Adolescent↗

PubMed2006

Development and implementation of pharmaceutical care planning software for nursing homes based on the Fleetwood Model.

PURPOSE: The effectiveness of pharmaceutical care planning software for nursing homes and the extent to which the software assisted in the implementation of the Fleetwood Model are described. METHODS: During the study, one long-term-care pharmacy identified 13 nursing homes to participate in the intervention group of a study evaluating the effectiveness of the Fleetwood Model. To successfully implement the Fleetwood Model, which demands prospective drug regimen review and collaborative practices between dispensing and consultant pharmacists, a software system that exchanged information between these pharmacists was deemed necessary. Pharmacists' self-reported assessments of the use of the software and the technical difficulties reported with its use were collected. The number of interventions performed by pharmacist type, the proportion of residents receiving interventions by multiple pharmacists, and the extent to which the interventions were prospective and performed before the mandated 30-day review were estimated from data documented in the software. The consistency of software use by the pharmacists was also estimated. RESULTS: Seventy-one percent of dispensing pharmacists and 40% of consultant pharmacists reported using the software most or all of the time. Fourteen percent of dispensing pharmacists and 40% of consultant pharmacists reported technical difficulties with the software. Over half of newly admitted or readmitted residents received a Fleetwood intervention within 3 days of admittance into the nursing home-71.2% occurred in less than 30 days of admission. CONCLUSION: The use of information technology to increase communication among health care professionals and assist in providing prospective drug regimen review in long-term-care facilities is feasible. Collaboration and extensive field testing with end users, realistic expectations, appropriate training, and technical support are necessary when implementing new technology.

Aged↗

PubMed2004

Factors influencing the implementation of quality use of medicines in residential aged care.

BACKGROUND: In response to concerns about, and issues pertaining to, medication use practices in residential aged-care facilities (RACFs), the Australian Pharmaceutical Advisory Council (APAC) established a working party on quality use of medicines (QUM) in nursing homes and hostels. The APAC is a representative ministerial advisory forum bringing together key stakeholders from the medical, nursing and pharmacy professions, as well as pharmaceutical industry, consumer and government sectors. The working party developed the integrated best practice model for medication management in RACFs. OBJECTIVES: This study arose from concerns that, despite the availability of such guidelines to inform best practice in RACFs, there remain barriers to its implementation. Thus, the focus of this research was to explore factors influencing the implementation of best practice with respect to QUM in RACFs. METHODS: This multimethod, multidisciplinary study was conducted in a representative sample of 12 RACFs in one Australian state - South Australia. The methods used were Critical Incident Technique (CIT) interviews, focus groups, nominal groups and Participatory Action Research. RESULTS: In stage one of the research the CIT interviews identified four major issues/factors influencing the implementation of best practice: contextual/structural, boundaries, day-to-day practices and keeping up. These themes were developed in the focus and nominal group sessions and the project team prepared a discussion paper summarising stage one results. In stage two participants were asked to use the discussion paper to develop a way forward. Medication Advisory Committees (MACs) emerged as a key strategy. Each participating RACF was then supported to establish and maintain a MAC. A second workshop heard feedback from the facilities on factors supporting the MACs and barriers to their functioning. Eleven of the 12 RACFs had a functioning MAC at the end of the project. Key support factors included: an external facilitator to help organise MAC meetings, provision of resources, such as terms of reference, agendas, policy statements and the sharing of information between MACs. In stage three a set of agreed recommendations was prepared and submitted to the funding body. The recommendations reported here informed the development of the peak guidelines for medication management and administration in Australia. CONCLUSION: This project has been groundbreaking in its impact on Australian aged-care practice. A major outcome has been significantly improved communication and collaboration between industry organisations, academic disciplines, professional bodies and educators involved in the RACFs.

Aged↗

PubMed2006

Implementing ADM1 for plant-wide benchmark simulations in Matlab/Simulink.

The IWA Anaerobic Digestion Model No.1 (ADM1) was presented in 2002 and is expected to represent the state-of-the-art model within this field in the future. Due to its complexity the implementation of the model is not a simple task and several computational aspects need to be considered, in particular if the ADM1 is to be included in dynamic simulations of plant-wide or even integrated systems. In this paper, the experiences gained from a Matlab/Simulink implementation of ADM1 into the extended COST/IWA Benchmark Simulation Model (BSM2) are presented. Aspects related to system stiffness, model interfacing with the ASM family, mass balances, acid-base equilibrium and algebraic solvers for pH and other troublesome state variables, numerical solvers and simulation time are discussed. The main conclusion is that if implemented properly, the ADM1 will also produce high-quality results in dynamic plant-wide simulations including noise, discrete sub-systems, etc. without imposing any major restrictions due to extensive computational efforts.

Anaerobiosis↗

PubMed2005

An evaluation of the fidelity of implementation of a school-based drug abuse prevention program: project toward no drug abuse (TND).

This article provides an implementation fidelity evaluation of the fourth experimental trial of Project Towards No Drug Abuse (TND). Two theoretical content components of the curriculum were examined to increase our understanding of the active ingredients of successful drug abuse prevention programs. A total of 18 senior high schools were randomly assigned by block to receive one of three conditions: cognitive perception information curriculum, cognitive perception information + behavioral skills curriculum, or standard care (control). These curricula were delivered to both regular and continuation high schools students (n=2331) by trained project health educators and regular classroom teachers. Across all program schools, the two different curricula were implemented as intended, were received favorably by students, and showed significant improvements in knowledge specific to the theoretical content being delivered. This pattern of results suggests that the experimental manipulations worked as intended, and thus, permit the attribution of future behavioral outcome differences between conditions to differences in content of Project TND material provided rather than to differences in the fidelity of delivery. Further, our findings indicate that Project TND can be implemented effectively with low and high risk youth in a general environment as well as with high risk youth in a more specialized environment.

Adolescent↗

PubMedDate not supplied

Design and implementation of a portal for the medical equipment market: MEDICOM.

BACKGROUND: The MEDICOM (Medical Products Electronic Commerce) Portal provides the electronic means for medical-equipment manufacturers to communicate online with their customers while supporting the Purchasing Process and Post Market Surveillance. The Portal offers a powerful Internet-based search tool for finding medical products and manufacturers. Its main advantage is the fast, reliable and up-to-date retrieval of information while eliminating all unrelated content that a general-purpose search engine would retrieve. The Universal Medical Device Nomenclature System (UMDNS) registers all products. The Portal accepts end-user requests and generates a list of results containing text descriptions of devices, UMDNS attribute values, and links to manufacturer Web pages and online catalogues for access to more-detailed information. Device short descriptions are provided by the corresponding manufacturer. The Portal offers technical support for integration of the manufacturers Web sites with itself. The network of the Portal and the connected manufacturers sites is called the MEDICOM system. OBJECTIVES: To establish an environment hosting all the interactions of consumers (health care organizations and professionals) and providers (manufacturers, distributors, and resellers of medical devices). METHODS: The Portal provides the end-user interface, implements system management, and supports database compatibility. The Portal hosts information about the whole MEDICOM system (Common Database) and summarized descriptions of medical devices (Short Description Database); the manufacturers servers present extended descriptions. The Portal provides end-user profiling and registration, an efficient product-searching mechanism, bulletin boards, links to on-line libraries and standards, on-line information for the MEDICOM system, and special messages or advertisements from manufacturers. Platform independence and interoperability characterize the system design. Relational Database Management Systems are used for the system s databases. The end-user interface is implemented using HTML, Javascript, Java applets, and XML documents. Communication between the Portal and the manufacturers servers is implemented using a CORBA interface. Remote administration of the Portal is enabled by dynamically-generated HTML interfaces based on XML documents. A representative group of users evaluated the system. The aim of the evaluation was validation of the usability of all of MEDICOM s functionality. The evaluation procedure was based on ISO/IEC 9126 Information technology - Software product evaluation - Quality characteristics and guidelines for their use. RESULTS: The overall user evaluation of the MEDICOM system was very positive. The MEDICOM system was characterized as an innovative concept that brings significant added value to medical-equipment commerce. CONCLUSIONS: The eventual benefits of the MEDICOM system are (a) establishment of a worldwide-accessible marketplace between manufacturers and health care professionals that provides up-to-date and high-quality product information in an easy and friendly way and (b) enhancement of the efficiency of marketing procedures and after-sales support.

Advertising↗

PubMedDate not supplied

Use of the World Wide Web to implement clinical practice guidelines: a feasibility study.

BACKGROUND: Important efforts have been invested in the past few years in the development of quality clinical guidelines. However, the means for the effective dissemination of guidelines to practicing physicians have not been determined. Several studies have examined the possibilities offered by the World Wide Web (the Web), but studies examining the implementation of clinical guidelines in actual practice are clearly lacking. OBJECTIVE: This study assessed the potential of the Web to implement clinical practice guidelines in actual clinical settings. It also documents the obstacles perceived by the physicians in their use of guidelines on the Internet to determine the role that the Web can play in the implementation of guidelines in practice. METHODS: Two guidelines were developed using a standardized panel method and made available via the Web. One concerned indications for low-back surgery and the other dealt with indications for upper and lower digestive endoscopies. To identify obstacles to their use in clinical practice, 20 physicians were asked to consult the guidelines during consultations with patients. Answers were collected using 3 different questionnaires. RESULTS: Questionnaires were completed for consultations involving 213 patients. Less than 50% of the physicians have direct access to the Internet in their examination room. For 75%, the use of the guidelines was easy and the time required to consult them acceptable (3.4 minutes on average, or 12% of the time spent with the patient). The fear that use of such guidelines might interfere with the physician-patient relationship was mentioned as a reason for not consulting the guidelines for 27 consultations. Taking into account their experience with the Web, 75% of the physicians considered that the Web has a great or very-great potential for the dissemination of guidelines and 78% indicated that they would use such guidelines if they became generally available for clinical questions that concerned them. Only 3 physicians had consulted guidelines on the Web prior to this study. CONCLUSIONS: The acceptance of use of clinical practice guidelines via the Web is high. The main limits to further use of such Web-based guidelines seem to be the lack of a computer connection in the physician's office or examining room and the fear that use of such guidelines might interfere with the physician-patient relationship. Though most participants appreciate the considerable potential of the Web for disseminating guidelines, only a small handful regularly use guidelines available on the Web. There are still numerous obstacles to the regular use of guidelines in clinical practice, some related to the physicians, others to the guidelines themselves.

Decision Support Systems, Clinical↗

PubMed2001

A model educational program for people with type 2 diabetes: a cooperative Latin American implementation study (PEDNID-LA).

OBJECTIVE: To implement an educational program in 10 Latin American countries and to evaluate its effect on the clinical, biochemical, and therapeutic aspects as well as the economic cost of diabetes. RESEARCH DESIGN AND METHODS: Educators from each participating country were previously trained to implement the educational model. The patient population included 446 individuals with type 2 diabetes; all patients were <65 years of age, did not require insulin for metabolic control, did not have severe complications of diabetes or life-limiting illnesses, and had not previously participated in diabetes education courses. Clinical and therapeutic data and the cost of their pharmacological treatment were collected 6 months before participation in the educational program (-6 months), on entry into the program (time 0), and at 4, 8, and 12 months after initiation of the program. RESULTS: All parameters measured had improved significantly (P < 0.001) by 1 year: fasting blood glucose (mean +/- SD) 10.6 +/- 3.5 vs. 8.7 +/- 3.0 mmol/l; HbA(1c) 9.0 +/- 2.0 vs. 7.8 +/- 1.6%; body weight 84.6 +/- 14.7 vs. 81.2 +/- 15.2 kg; systolic blood pressure 149.6 +/- 33.6 vs. 142.9 +/- 18.8 mmHg; total cholesterol 6.1 +/- 1.1 vs. 5.4 +/- 1.0 mmol/l; and triglycerides 2.7 +/- 1.8 vs. 2.1 +/- 1.2 mmol/l. At 12 months, the decrease in pharmacotherapy required for control of diabetes, hypertension, and hyperlipidemia represented a 62% decrease in the annual cost of treatment ($107,939.99 vs. $41,106.30 [U.S.]). After deducting the additional cost of glucosuria monitoring ($30,604), there was still a 34% annual savings. CONCLUSIONS: The beneficial results of this educational model, implemented in 10 Latin American countries, reinforce the value of patient education as an essential part of diabetes care. They also suggest that an educational approach promoting healthy lifestyle habits and patient empowerment is an effective strategy with the potential to decrease the development of complications related to diabetes as well as the socioeconomic costs of the disease.

Adult↗