Cluster randomised controlled trial of a theory-based multiple behaviour change intervention aimed at healthcare professionals to improve their management of type 2 diabetes in primary care

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Presseau , J , Mackintosh , J , Hawthorne , G , Francis , J J , Johnston , M , Grimshaw , J M , Steen , N , Coulthard , T , Brown , H , Kaner , E , Elovainio , M & Sniehotta , F F 2018 , ' Cluster randomised controlled trial of a theory-based multiple behaviour change intervention aimed at healthcare professionals to improve their management of type 2 diabetes in primary care ' , Implementation Science , vol. 13 , 65 . https://doi.org/10.1186/s13012-018-0754-5

Title: Cluster randomised controlled trial of a theory-based multiple behaviour change intervention aimed at healthcare professionals to improve their management of type 2 diabetes in primary care
Author: Presseau, Justin; Mackintosh, Joan; Hawthorne, Gillian; Francis, Jill J.; Johnston, Marie; Grimshaw, Jeremy M.; Steen, Nick; Coulthard, Tom; Brown, Heather; Kaner, Eileen; Elovainio, Marko; Sniehotta, Falko F.
Other contributor: University of Helsinki, Department of Psychology and Logopedics

Date: 2018-05-02
Language: eng
Number of pages: 10
Belongs to series: Implementation Science
ISSN: 1748-5908
DOI: https://doi.org/10.1186/s13012-018-0754-5
URI: http://hdl.handle.net/10138/299473
Abstract: Background: National diabetes audits in the UK show room for improvement in the quality of care delivered to people with type 2 diabetes in primary care. Systematic reviews of quality improvement interventions show that such approaches can be effective but there is wide variability between trials and little understanding concerning what explains this variability. A national cohort study of primary care across 99 UK practices identified modifiable predictors of healthcare professionals' prescribing, advising and foot examination. Our objective was to evaluate the effectiveness of an implementation intervention to improve six guideline-recommended health professional behaviours in managing type 2 diabetes in primary care: prescribing for blood pressure and glycaemic control, providing physical activity and nutrition advice and providing updated diabetes education and foot examination. Methods: Two-armed cluster randomised trial involving 44 general practices. Primary outcomes (at 12 months follow-up): from electronic medical records, the proportion of patients receiving additional prescriptions for blood pressure and insulin initiation for glycaemic control and having a foot examination; and from a patient survey of a random sample of 100 patients per practice, reported receipt of updated diabetes education and physical activity and nutrition advice. Results: The implementation intervention did not lead to statistically significant improvement on any of the six clinical behaviours. 1,138,105 prescriptions were assessed. Intervention (29% to 37% patients) and control arms (31% to 35%) increased insulin initiation relative to baseline but were not statistically significantly different at follow-up (IRR 1.18, 95% CI 0.95-1.48). Intervention (45% to 53%) and control practices (45% to 50%) increased blood pressure prescription from baseline to follow-up but were not statistically significantly different at follow-up (IRR 1.05, 95% CI 0.96 to 1.16). Intervention (75 to 78%) and control practices (74 to 79%) increased foot examination relative to baseline; control practices increased statistically significantly more (OR 0.84, 95% CI 0.75-0.94). Fewer patients in intervention (33%) than control practices (40%) reported receiving updated diabetes education (OR = 0.74, 95% CI 0.57-0.97). No statistically significant differences were observed in patient reports of having had a discussion about nutrition (intervention = 73%; control = 72%; OR = 0.98, 95% CI 0.59-1.64) or physical activity (intervention = 57%; control = 62%; OR = 0.79, 95% CI 0. 56-1.11). Development and delivery of the intervention cost 1191 pound per practice. Conclusions: There was no measurable benefit to practices' participation in this intervention. Despite widespread use of outreach interventions worldwide, there is a need to better understand which techniques at which intensity are optimally suited to address the multiple clinical behaviours involved in improving care for type 2 diabetes.
Subject: Diabetes
Health care professional
Behaviour change
Primary care
Cluster randomized trial
Blood pressure
HbA(1c)
Lifestyle advice
Foot examination
Theory
Multiple behaviours
RESEARCH-COUNCIL GUIDANCE
QUALITY-OF-CARE
COMPLEX INTERVENTIONS
AUTOMATIC PROCESSES
BLACK-BOX
METAANALYSIS
PERFORMANCE
FEEDBACK
LOOKING
AUDIT
3141 Health care science
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