Diabetes in rural towns: effectiveness of continuing education and feedback for healthcare providers in altering diabetes outcomes at a population level: protocol for a cluster randomised controlled trial

Abstract

BackgroundType 2 diabetes is one of the fastest growing chronic diseases internationally. The health complications associated with type 2 diabetes can be prevented, delayed, or improved via early diagnosis and effective management. This research aims to examine the impact of a primarily web-based educational intervention on the diabetes care provided by general practitioners (GPs) in rural areas, and subsequent patient outcomes. A population-level approach to outcome assessment is used, via whole-town de-identified pathology records.Methods/designThe study uses a cluster randomised controlled trial with rural communities as the unit of analysis. Towns from four Australian states were selected and matched on factors including rurality, population size, proportion of the population who were Indigenous Australians, and socio-economic status. Eleven pairs of towns from two states were suitable for the trial, and one town from each pair was randomised to the experimental group. GPs in the towns allocated to the experimental group are offered an intervention package comprising education on best practice diabetes care via an on-line active learning module, a moderated discussion forum, access to targeted and specialist advice through an on-line request form, and town-based performance feedback on diabetes monitoring and outcomes. The package is offered via repeated direct mail.DiscussionThe benefits of the outcomes of the trial are described along with the challenges and limitations associated with the methodology.Trial registrationAustralian New Zealand Clinical Trials Registry: ACTRN12611000553976

Health Research Participation, Opportunity, and Willingness Among Minority and Rural Communities of Arkansas

“…This is not consistent with prior literature that shows rural populations have lower opportunity and participation rates 5, 22, 23, 24, 25, 26. This unexpected finding could be influenced by the extensive community‐based participatory research capacity that the states only academic medical center (University of Arkansas for Medical Sciences) had invested in to better engage rural and minority participants.…”

Poor uptake of an online intervention in a cluster randomised controlled trial of online diabetes education for rural general practitioners

“…Allocation remained concealed to all participants and all those assessing outcomes throughout the study. The selection, matching and randomisation of towns, and sample size calculation is described in more detail in the study protocol [21]. In the intervention towns, the intervention was offered to all listed GPs found to be practising in that town.…”

“…The centerpiece of the intervention was an online Active Learning Module (ALM), a structured learning tool for which GPs received continuing professional development points via their professional body. The protocol for this trial has been published [21]. This paper will describe the uptake of the CME intervention and its impact on the viability of the trial.…”

Patterns of type 2 diabetes monitoring in rural towns: How does frequency of HbA1c and lipid testing compare with existing guidelines?

“…Figure illustrates case sample selection and data collection from rural and regional pathology services. The complete method is described elsewhere . Laboratory test results reported for each individual included HbA1c, blood lipids (cholesterol, low‐density lipoprotein (LDL) cholesterol, high‐density lipoprotein (HDL) cholesterol and triglycerides).…”

“…The data presented here relate to the baseline period of the intervention trial described in Paul et al . 2013 . A study case of type 2 diabetes was defined as having either a single HbA1c test where the result was higher than the recommended level of 7.0% (53 mmol mol −1 ); or two or more HbA1c tests within the study period, and at least 6 months between such a test and the close of the data collection period.…”