Improving services for people with diabetes: Lessons from setting up the DREAM trial

Abstract

The DREAM trial (a randomised, controlled trial of a patient-based Diabetes REcall And Management system) was designed to evaluate the effectiveness and efficiency of an area-wide 'extended' computerised diabetes register. This comprised a structured recall and management system, actively involving patients, and incorporating clinical management prompts to primary care clinicians based on locally-adapted, evidence-based guidelines. This paper presents the findings from the process of setting up and running the trial; important lessons have been learnt from producing the guidelines, introducing the new software into the diabetes register, and the early months of running the system. These points have implications for diabetes registers in general, and are of particular relevance to the implementation of the National Service Framework for Diabetes in England. In particular, most diabetes registers have not been used as recall systems, usually functioning as little more than data recording mechanisms. However, it is possible to develop diabetes register software that not only functions as a recall system, but also generates clinical management prompts based on guidelines, in response to a wide range of clinical variables entered onto the system. Copyright © 2004 John Wiley & Sons, Ltd.