A case study on the impact of the Evidence2Practice Diabetes EMR tool in primary care

In 2024, an estimated 4.4 million Ontarians were living with prediabetes and type 2 diabetes (diagnosed and undiagnosed).¹ People with diabetes are at risk of developing serious complications, including severe hypoglycemia, long-term microvascular complications affecting the eyes, kidneys, and nerves, as well as coronary artery disease, stroke and heart failure.² These complications can often be prevented or delayed through proactive and appropriate screening, yet research on adherence to evidence-based best practices suggests variability in the implementation of best practices across care settings.³ Deviations from best practices for patients with diabetes must be minimized, as adherence to evidence-based best practices in diabetes care is crucial for effective disease management and reducing the risk of complications.⁴

E2P’s EMR-integrated point-of-care tools provide clinicians with access to the right evidence at the right time, allowing them to focus on caring for their patients while simultaneously ensuring their clinical practice is in alignment with best practices. Grounded in Ontario Health’s quality standard, the E2P diabetes tool supports clinicians in the early identification of patients at risk, monitoring and assessing glycemic targets, assessing risk factors and complications of diabetes using standardized testing, and providing patient education and resources.

Impact in practice

Feedback gathered from primary care physicians highlights the effectiveness and applicability of E2P tools:

This case study explores how the E2P Diabetes EMR tool supports evidence-based diabetes care. By examining real-world use, this case study seeks to highlight the tool’s impact on clinical practice, ensure alignment with best practices, and identify opportunities to further support clinicians in delivering high-quality diabetes care.

Dr. B. Newton is an independent physician in the Toronto region who began using the E2P Diabetes tool in September 2023. She has accessed both change management support and academic detailing through the E2P program. To better understand the impact of the tool on patient care, we evaluated Dr. Newton’s tool use over a 7-month period. Her practice includes:

For her patients with diabetes with whom she used the E2P DM tool, we found that:

Best practices recommend that people with diabetes be screened for complications and risk factors at least annually.⁵ One of the more serious and common complications associated with diabetes is diabetic foot ulcers, which cause about a third of all nontraumatic below-the-knee amputations in Canada.3 Yet only 53% of Canadians with diabetes reported receiving a foot exam by a healthcare professional in the past year.⁶

Diabetic foot ulcers affect up to 25% of individuals with diabetes.⁷ Rates of lower-limb amputations vary significantly across Ontario Health Regions, with the highest rate being almost eight times that of the lowest.⁷ Based on the findings of this case study, the use of E2P tools at the point of care has the potential to standardize and improve the care of patients with pre-diabetes and type 2 diabetes across Ontario.

Works Cited

1. Diabetes Ontario. “Diabetes in Ontario.” 2024 [Online]. Available at: https://www.diabetes.ca/getmedia/c12dd228-2061-443f-a45dd28e6ccde0ed/DC_2024_Backgrounder_OnePager_ON_Nov2024.pdf
2. Diabetes Canada. “Type 2 Complications.” (n.d.) [Online]. Available at: https://www.diabetes.ca/about-diabetes/type-2/complications
3. Pun, N., Shah, B., Hoffe, L., Dhruv, M., & Besner, A. (2023). ADHERENCE TO GUIDELINE-RECOMMENDED MONITORING OF IMPORTANT PARAMETERS RELATING TO DIABETES MELLITUS IN ONTARIO. Canadian Journal of Cardiology, 39(10), S121–S122. https://doi.org/10.1016/j.cjca.2023.06.191
4. Valencia, Y., & Dols, J. D. (2021). Facilitating Adherence to Evidence-Based Practices for Adults With Type 2 Diabetes Mellitus. Journal for Nurse Practitioners, 17(6), 744–748. https://doi.org/10.1016/j.nurpra.2020.12.027
5. Ontario Health. “Prediabetes and Type 2 Diabetes Care for People of All Ages.” Quality Standards, 2021 [Online]. Available at:
   https://www.hqontario.ca/Portals/0/documents/evidence/quality-standards/qs-prediabetes-and-type-2-diabetes-quality-standard-en.pdf
6. Patel, J., Zamzam, A., Syed, M., Blanchette, V., Cross, K., Albalawi, Z., Al-Omran, M., & de Mestral, C. (2022). A Scoping Review of Foot Screening in Adults With Diabetes Mellitus Across Canada. Canadian Journal of Diabetes, 46(5), 435-440.e2. https://doi.org/10.1016/j.jcjd.2022.01.004
7. Ontario Health. “Diabetic Foot Ulcers Care for Patients in All Settings.” Quality Standards, 2017 [Online]. Available at:
   https://www.hqontario.ca/Portals/0/documents/evidence/quality-standards/qs-diabetic-foot-ulcers-clinical-guide-en.pdf
   

This document is not to be reprinted without permission from the Evidence2Practice Ontario program.

Evidence2Practice Ontario (E2P) brings together multi-disciplinary, cross-sector expertise under the joint leadership of the Centre for Effective Practice, Amplify Care, and North York General Hospital. Funding and strategic guidance for E2P is provided by Ontario Health in support of Ontario’s Digital First for Health Strategy.