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

Justin Presseau, Joan Mackintosh, Gillian Hawthorne, Jill J. Francis, Marie Johnston, Jeremy M. Grimshaw, Nick Steen, Tom Coulthard, Heather Brown, Eileen Kaner, Marko Elovainio, Falko F. Sniehotta

Forskningsoutput: TidskriftsbidragArtikelVetenskapligPeer review

Sammanfattning

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.
Originalspråkengelska
Artikelnummer65
TidskriftImplementation Science
Volym13
Antal sidor10
ISSN1748-5908
DOI
StatusPublicerad - 2 maj 2018
MoE-publikationstypA1 Tidskriftsartikel-refererad

Vetenskapsgrenar

  • 3141 Hälsovetenskap

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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. / 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. I: Implementation Science. 2018 ; Vol. 13.
@article{5228fe4a91bd4098aa48aefd366209bf,
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",
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.",
keywords = "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",
author = "Justin Presseau and Joan Mackintosh and Gillian Hawthorne and Francis, {Jill J.} and Marie Johnston and Grimshaw, {Jeremy M.} and Nick Steen and Tom Coulthard and Heather Brown and Eileen Kaner and Marko Elovainio and Sniehotta, {Falko F.}",
year = "2018",
month = "5",
day = "2",
doi = "10.1186/s13012-018-0754-5",
language = "English",
volume = "13",
journal = "Implementation Science",
issn = "1748-5908",
publisher = "BioMed Central Ltd",

}

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. / 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.

I: Implementation Science, Vol. 13, 65, 02.05.2018.

Forskningsoutput: TidskriftsbidragArtikelVetenskapligPeer review

TY - JOUR

T1 - 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

AU - Presseau, Justin

AU - Mackintosh, Joan

AU - Hawthorne, Gillian

AU - Francis, Jill J.

AU - Johnston, Marie

AU - Grimshaw, Jeremy M.

AU - Steen, Nick

AU - Coulthard, Tom

AU - Brown, Heather

AU - Kaner, Eileen

AU - Elovainio, Marko

AU - Sniehotta, Falko F.

PY - 2018/5/2

Y1 - 2018/5/2

N2 - 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.

AB - 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.

KW - Diabetes

KW - Health care professional

KW - Behaviour change

KW - Primary care

KW - Cluster randomized trial

KW - Blood pressure

KW - HbA(1c)

KW - Lifestyle advice

KW - Foot examination

KW - Theory

KW - Multiple behaviours

KW - RESEARCH-COUNCIL GUIDANCE

KW - QUALITY-OF-CARE

KW - COMPLEX INTERVENTIONS

KW - AUTOMATIC PROCESSES

KW - BLACK-BOX

KW - METAANALYSIS

KW - PERFORMANCE

KW - FEEDBACK

KW - LOOKING

KW - AUDIT

KW - 3141 Health care science

U2 - 10.1186/s13012-018-0754-5

DO - 10.1186/s13012-018-0754-5

M3 - Article

VL - 13

JO - Implementation Science

JF - Implementation Science

SN - 1748-5908

M1 - 65

ER -