[Impact of peer visits]

To measure the impact of an intervention on the general practitioners (GP) of Reunion in order to improve the management of patients with type 2 diabetes, in conforming with the recommendations of the Anaes.

Randomised intervention study on a random sample of 120 practitioners out of a total of 630 GP in Reunion, 60 in the intervention group (IG) and 60 in the control group (CG). Each doctor of the IG received 2 visits by a "visiting GP" which have had specific training. The period of observation included the 12 months before, and the 6 months after the date of the intervention. Data were collected retrospectively, at the end of 18 months of observation; in medical records of 25 diabetics seen consecutively in consultation, the GP collected the dates of performance of six procedures under surveillance: HbA1c, examination of the feet, fundoscopy, ECG, estimation of the creatinine clearance, level of micro-albuminuria. Outcome measures were delays in performance of the procedures conforming to the recommendations.

42 GP out of 60 in the IG, and 40 out of 60 in the CG participated to the study. Patients included, 792 in the IG and 789 in the CG, were comparable for age, sex-ratio and profession. The distribution of delays in performance before the intervention was comparable in the two groups. The comparison between the groups after the intervention showed a significantly important improvement in the IG for 4 to 6 of the procedures: examination of the feet, fundoscopy, creatinine clearance and micro-albuminuria.

In the short-term, a "outreach visit" or "academic detailing" improves the delay in performance of most of the surveillance procedures in type 2 diabetes.