Implementing a national diabetes prevention programme in England: lessons learned

Stokes, Jonathan; Gellatly, Judith; Bower, Peter; Meacock, Rachel; Cotterill, Sarah; Sutton, Matt; Wilson, Paul

doi:10.1186/s12913-019-4809-3

Cited by 31 publications

(33 citation statements)

References 28 publications

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“…Ultimately, the goal is to understand who needs to do what in order to implement and sustain an innovation, what factors are likely to facilitate or impede those changes, and what strategies need to be in place in order to address anticipated or emergent challenges [116,117]. The implementation and scale-up of the U.K. Diabetes Prevention Programme show the importance of stakeholder engagement, addressing contextual conditions (e.g., staff turnover), and the value of incentives [118].…”

Section: Design and Tailor Implementation Strategiesmentioning

confidence: 99%

Implementation science should give higher priority to health equity

et al. 2021

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Background There is growing urgency to tackle issues of equity and justice in the USA and worldwide. Health equity, a framing that moves away from a deficit mindset of what society is doing poorly (disparities) to one that is positive about what society can achieve, is becoming more prominent in health research that uses implementation science approaches. Equity begins with justice—health differences often reflect societal injustices. Applying the perspectives and tools of implementation science has potential for immediate impact to improve health equity. Main text We propose a vision and set of action steps for making health equity a more prominent and central aim of implementation science, thus committing to conduct implementation science through equity-focused principles to achieve this vision in U.S. research and practice. We identify and discuss challenges in current health disparities approaches that do not fully consider social determinants. Implementation research challenges are outlined in three areas: limitations of the evidence base, underdeveloped measures and methods, and inadequate attention to context. To address these challenges, we offer recommendations that seek to (1) link social determinants with health outcomes, (2) build equity into all policies, (3) use equity-relevant metrics, (4) study what is already happening, (5) integrate equity into implementation models, (6) design and tailor implementation strategies, (7) connect to systems and sectors outside of health, (8) engage organizations in internal and external equity efforts, (9) build capacity for equity in implementation science, and (10) focus on equity in dissemination efforts. Conclusions Every project in implementation science should include an equity focus. For some studies, equity is the main goal of the project and a central feature of all aspects of the project. In other studies, equity is part of a project but not the singular focus. In these studies, we should, at a minimum, ensure that we “leave no one behind” and that existing disparities are not widened. With a stronger commitment to health equity from funders, researchers, practitioners, advocates, evaluators, and policy makers, we can harvest the rewards of the resources being invested in health-related research to eliminate disparities, resulting in health equity.

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Section: Design and Tailor Implementation Strategiesmentioning

confidence: 99%

Implementation science should give higher priority to health equity

et al. 2021

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“…11 16 Between 2016 and 2019 the DPP was introduced across England in three waves, delivered by four private service providers. 17 The National Health Service (NHS) in England is organized geographically into clinical commissioning groups (CCGs), and at a higher level into sustainability and transformation partnerships (STPs). In general, a single provider was commissioned by each STP, but local implementation of referrals from primary care was managed by CCGs.…”

Section: Introductionmentioning

confidence: 99%

‘Going the distance’: an independent cohort study of engagement and dropout among the first 100 000 referrals into a large-scale diabetes prevention program

Howarth

Bower

Kontopantelis

et al. 2020

BMJ Open Diab Res Care

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IntroductionDiabetes prevention programs (DPPs) are effective, in a pre-diabetic population, in reducing weight, lowering glycated hemoglobin and slowing the progression to diabetes. Little is known about the relationship between participation in DPPsand participant characteristics or service delivery. We investigated uptake and retention in England’s NHS DPP, reporting on variability among patient subgroups, providers, and sites.Research design and methodsThis prospective cohort study included 99 473 adults with non-diabetic hyperglycemia referred to the English DPP between 2016 and 2017. The program seeks to change health behaviors by offering at least 16 hours of group education and exercise. Multilevel logistic regression models were used to analyze variation in uptake, retention, and completion.ResultsUptake among 99 473 adults referred to the program was 56% (55 275). Among 55 275 who started the program, 34% (18 562) achieved the required dose and 22% (12 127) completed the full course. After adjustment for variation in case mix, substantial heterogeneity in uptake and retention was seen across four service providers (uptake OR 1.77 (1.33, 2.34), 4.30 (3.01, 6.15), and 1.45 (1.07, 1.97) compared with the reference provider) and between sites (uptake for typical individuals ranged from 0.32 to 0.78 across the middle 95% of sites, intraclass correlation coefficient (ICC) 0.07). Higher levels of retention and completion were seen where some out-of-hours provision was offered (retention OR 1.32 (1.25, 1.39)).ConclusionsThis study provides the first independent assessment of participation in the English DPP and the first study internationally to examine the impact of DPP service delivery on participation. When implementing a large-scale DPP, heterogeneity in service provision between different providers and sites can result in variable participation beyond that attributable to case mix, with potential consequences for effectiveness and health inequalities. Extending out-of-hours provision may improve participation in prevention programs.

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“…As part of research exploring the local implementation of the programme (Stokes et al., 2019), we designed a questionnaire to identify the presence and type of incentives used to encourage general practices to generate referrals (North West—Greater Manchester East Research Ethics Committee REC reference 17/NW/0426). The questionnaire was sent to the lead CCG for each of the sites in May 2018, at which point roll‐out of the DPP had been completed in all wave 1 and 2 sites.…”

Section: Methodsmentioning

confidence: 99%

The effects of structure, process and outcome incentives on primary care referrals to a national prevention programme

et al. 2021

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Despite widespread use, evidence is sparse on whether financial incentives in healthcare should be linked to structure, process or outcome. We examine the impact of different incentive types on the quantity and effectiveness of referrals made by general practices to a new national prevention programme in England. We measured effectiveness by the number of referrals resulting in programme attendance. We surveyed local commissioners about their use of financial incentives and linked this information to numbers of programme referrals and attendances from 5170 general practices between April 2016 and March 2018. We used multivariate probit regressions to identify commissioner characteristics associated with the use of different incentive types and negative binomial regressions to estimate their effect on practice rates of referral and attendance. Financial incentives were offered by commissioners in the majority of areas (89%), with 38% using structure incentives, 69% using process incentives and 22% using outcome incentives. Compared to practices without financial incentives, neither structure nor process incentives were associated with statistically significant increases in referrals or attendances, but outcome incentives were associated with 84% more referrals and 93% more attendances. Outcome incentives were the only form of pay-for-performance to stimulate more participation in this national disease prevention programme.

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Implementing a national diabetes prevention programme in England: lessons learned

Cited by 31 publications

References 28 publications

Implementation science should give higher priority to health equity

Implementation science should give higher priority to health equity

‘Going the distance’: an independent cohort study of engagement and dropout among the first 100 000 referrals into a large-scale diabetes prevention program

The effects of structure, process and outcome incentives on primary care referrals to a national prevention programme

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