Practice Context Affects Efforts to Improve Diabetes Care for Primary Care Patients: A Pragmatic Cluster Randomized Trial

Dickinson, L. Miriam; Dickinson, W. Perry; Nutting, Paul A.; Fisher, Lawrence; Harbrecht, Marjie; Crabtree, Benjamin F.; Glasgow, Russell E.; West, D. R. F.

doi:10.1007/s11606-014-3131-3

Cited by 14 publications

(6 citation statements)

References 33 publications

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“…Practice-level measures include practice context, which often influence efforts to improve diabetes care [45], including measures of relational coordination (using the Relational Coordination Survey [42], a measure of teambased care designed to measure relational coordination, communication, and relationships in particular work processes in primary care teams [46]), practice CCMconsistent care (using the Assessment of Chronic Illness Care [[ACIC]) [43], and practice culture (using the Practice Culture Assessment) [47]. Practice representatives complete measures of SMA resource requirements using a time-driven activity-based costing framework [44] to assess use of staff time, workflows, required materials and supplies, and other resources needed to deliver each SMA model, distinguishing between early and late implementation phases.…”

Section: Practice-level Measuresmentioning

confidence: 99%

The Invested in Diabetes Study Protocol: a cluster randomized pragmatic trial comparing standardized and patient-driven diabetes shared medical appointments

Kwan

Dickinson

Glasgow

et al. 2020

Trials

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Background: Shared medical appointments (SMAs) have been shown to be an efficient and effective strategy for providing diabetes self-management education and self-management support. SMA features vary and it is not known which features are most effective for different patients and practice settings. The Invested in Diabetes study tests the comparative effectiveness of SMAs with and without multidisciplinary care teams and patient topic choice for improving patient-centered and clinical outcomes related to diabetes. Methods: This study compares the effectiveness of two SMA approaches using the Targeted Training for Illness Management (TTIM) curriculum. Standardized SMAs are led by a health educator with a set order of TTIM topics. Patient-driven SMAs are delivered collaboratively by a multidisciplinary care team (health educator, medical provider, behavioral health provider, and a peer mentor); patients select the order and emphasis on TTIM topics. Invested in Diabetes is a cluster randomized pragmatic trial involving approximately 1440 adult patients with type 2 diabetes. Twenty primary care practices will be randomly assigned to either standardized or patient-driven SMAs. A mixed-methods evaluation will include quantitative (practice-and patient-level data) and qualitative (practice and patient interviews, observation) components. The primary patient-centered outcome is diabetes distress. Secondary outcomes include autonomy support, self-management behaviors, clinical outcomes, patient reach, and practicelevel value and sustainability. Discussion: Practice and patient stakeholder input guided protocol development for this pragmatic trial comparing SMA approaches. Implementation strategies from the enhanced Replicating Effective Programs framework will help ensure practices maintain fidelity to intervention protocols while tailoring workflows to their settings. Invested in Diabetes will contribute to the literature on chronic illness management and implementation science using the RE-AIM model.

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Section: Practice-level Measuresmentioning

confidence: 99%

The Invested in Diabetes Study Protocol: a cluster randomized pragmatic trial comparing standardized and patient-driven diabetes shared medical appointments

Kwan

Dickinson

Glasgow

et al. 2020

Trials

Self Cite

View full text Add to dashboard Cite

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“…In a randomized clinical trial of 522 clinicians and staff members (both rural and urban), those practices with an effective work culture significantly improved diabetes care (e.g., HbA1c, foot examinations, lipid levels, eye examinations, renal screening), using either continuous quality improvement or self-directed approaches toward delivering quality chronic care to their clients. These findings highlight effective internal work relationships (e.g., teamwork) in providing effective diabetes self-management strategies for individuals with T2DM (Dickinson et al, 2015).…”

Section: Implications For Health Professionalsmentioning

confidence: 83%

Barriers to Diabetes Self-Management Among Rural Individuals in the Workplace

Grant

Steadman

2016

Workplace Health Saf

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Higher rates of type 2 diabetes mellitus (T2DM) are found in rural populations and barriers lessen the ability of these individuals to effectively manage diabetes. By lessening potential barriers to self-care management, health professionals, especially occupational health nurses, can assist individuals confidently manage T2DM. In this article, the authors provide an overview of diabetes self-management barriers for rural populations and implications for health professionals who assist individuals with T2DM in the workplace.

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“…Even after a hypothetical adaptation, results and products would be context specific. That is, context is crucial, meaning that interventions may be implemented in different ways in different settings and thus outcomes may also vary [ 37 – 39 ].…”

Section: Discussionmentioning

confidence: 99%

Feasibility of an implementation strategy for the integration of health promotion in routine primary care: a quantitative process evaluation

et al. 2017

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BackgroundProcess evaluation is recommended to improve the understanding of underlying mechanisms related to clinicians, patients, context and intervention delivery that may impact on trial or program results, feasibility and transferability to practice. The aim of this study was to assess the feasibility of the Prescribe Healthy Life (PVS from the Spanish “Prescribe Vida Saludable”) implementation strategy for enhancing the adoption and implementation of an evidence-based health promotion intervention in primary health care.MethodsA descriptive study of 2-year implementation indicators for the PVS clinical intervention was conducted in four primary health care centers. A multifaceted collaborative modeling implementation strategy was developed to enhance the integration of a clinical intervention to promote healthy lifestyles into clinical practice. Process indicators were assessed for intervention reach, adoption, implementation, sustainability and their variability at center, practice, and patient levels.ResultsMean rates of adoption by means of active collaboration among the three main professional categories (family physicians, nurses and administrative personnel) were 75% in all centers. Just over half of the patients that attended (n = 11650; 51.9%) were reached in terms of having their lifestyle habits assessed, while more than a third (33.7%; n = 7433) and almost 10% (n = 2175) received advice or a printed prescription for at least one lifestyle change, respectively. Only 3.7% of the target population received a repeat prescription. These process indicators significantly (p < 0.001) varied by center, lifestyle habit and patient characteristics. Sustainability of intervention components changed thorough the implementation period within centers.ConclusionsThe implementation strategy used showed moderate-to-good performance on process indicators related to adoption, reach, and implementation of the evidence-based healthy lifestyle promotion intervention in the context of routine primary care.Sources of heterogeneity and instability in these indicators may improve our understanding of factors required to attain adequate program adoption and implementation through improved implementation strategies.Electronic supplementary materialThe online version of this article (doi:10.1186/s12875-017-0585-5) contains supplementary material, which is available to authorized users.

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Practice Context Affects Efforts to Improve Diabetes Care for Primary Care Patients: A Pragmatic Cluster Randomized Trial

Cited by 14 publications

References 33 publications

The Invested in Diabetes Study Protocol: a cluster randomized pragmatic trial comparing standardized and patient-driven diabetes shared medical appointments

The Invested in Diabetes Study Protocol: a cluster randomized pragmatic trial comparing standardized and patient-driven diabetes shared medical appointments

Barriers to Diabetes Self-Management Among Rural Individuals in the Workplace

Feasibility of an implementation strategy for the integration of health promotion in routine primary care: a quantitative process evaluation

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