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, 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, proportion of patients receiving additional prescriptions for blood pressure and insulin initiation for glycaemic control, and having a foot examination; from a patient survey of random sample of 100 patients per practice, reported receipt of updated diabetes education, and physical activity and nutrition advice and education.
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 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 the address multiple clinical behaviours involved in improved care for Type 2 diabetes
- Health Care Professional
- Behaviour Change
- Primary Care
- Cluster randomized trial
- Blood pressure
- Lifestyle advice
- Foot examination
- Multiple Behaviours