Lookup NU author(s): Dr Justin Presseau,
Dr Gillian Hawthorne,
Dr Jill Francis,
Professor Marie Johnston,
Professor Jeremy Grimshaw,
Dr Nick Steen,
Dr Tom Coulthard,
Dr Heather Brown,
Professor Eileen Kaner,
Professor Falko Sniehotta
This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).
Objective: Evaluate the effectiveness of an 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, providing updated diabetes education and foot examination. Design: Two-armed cluster randomised trial with general practices as the unit of randomization. Setting: General practices in the North East of England. Participants: General practitioners, nurses and healthcare assistants in 44 practices, and the adult patients with type 2 diabetes registered in their practice. Intervention: One 90-minute behaviour change outreach visit delivered jointly by a content expert and a behaviour change expert, involving behaviour change techniques targeting factors demonstrated to account for variance in the targeted clinical behaviours. Main outcome measures: At 12 months follow-up, proportion of patients: receiving additional prescriptions for blood pressure and glycaemic control; having a foot examination, extracted from anonymised patient electronic records; and reporting receipt of physical activity advice, nutrition advice and updated diabetes education from anonymised survey of 100 patients per practice. Results: The intervention did not lead to statistically significant improvement on any of the six clinical behaviours. Both 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 12 months follow-up (IRR: 1.05, 95%CI 0.96 to 1.16). Both intervention (75% to 78%) and control practices (74% to 79%) increased foot examination relative to baseline, with control practices increasing statistically significantly more (OR: 0.84, 95%CI 0.75-0.94). Fewer patients in intervention practices (33%) than control practices (40%) reported receiving updated diabetes education advice (OR=0.74, 95%CI 0.57-0.97) at follow-up. 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 per practice. Discussion: There was no measurable benefit to practices’ participation in this behaviour change outreach visit intervention. Despite targeting evidenced determinants of clinicians’ behaviour, improvements in care for type 2 diabetes may require more than a single session to address the multiple clinical behaviours involved in improving care for type 2 diabetes.
Author(s): Presseau J, Mackintosh J, Hawthorne G, Francis JJ, Johnston M, Grimshaw JM, Steen N, Coulthard T, Brown H, Kaner E, Elovaninio M, Sniehotta FF
Publication type: Article
Publication status: Published
Journal: Implementation Science
Online publication date: 02/05/2018
Acceptance date: 19/04/2018
ISSN (electronic): 1748-5908
Publisher: BioMed Central Ltd.
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