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A randomized controlled trial of an intervention designed to improve the care given in general practice to Type II diabetic patients: patient outcomes and professional ability to change behaviour
Abstract
AIM: Our objective was to evaluate the effect of training in a patient-centred intervention for GPs and practice nurses on outcomes for patients with Type II diabetes. METHODS: We carried out a randomized controlled trial within general practices as the basis for randomization and a before-and-after design for measures of patient outcome. A parallel process study examined the use of the method by professionals. The study was carried out in 29 general practices in South Glamorgan who had participated for at least 2 years in a local scheme of audit and CME in relation to Type II diabetes care. The subjects were 252 Type II diabetic patients recruited by 15 experimental and 14 control practices. The main outcome measures were changes in glycosylated haemoglobin, patient satisfaction with care and treatment, functional health status and professional ability to apply the intervention. RESULTS: Professionals adopted the innovative method with enthusiasm, but after 2 years only 19% continued to apply the method systematically. The trial was, therefore, unable to demonstrate significant biochemical or functional improvements. This highlights the need to understand the factors associated with professional uptake and subsequent ability to sustain changes in behaviour. CONCLUSIONS: The efficacy of this behavioural intervention remains unproved, despite its acceptability to professional staff. Detailed and prolonged development and testing of behavioural interventions is an essential first step before embarking on randomized controlled trials which involve complex behavioural changes in professionals or patients.
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“while four made no such adjustments (Alamo 2002; McLean 2004; Pill 1998; Meland 1997).”
From Interventions for providers to promote a patient-centred approach in clinical consultations (2012) · cites this paper as Pill 1998
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“Implementation barriers included providers’ ability to respond to emotional issues and to allow patients to solve their own problems [6], lack of competence in method [12] and choosing not to use the method [15] or some parts of the method [16].”
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“In addition, difficulties in long term maintenance of new skills acquired in motivational, behaviour change methods has also been highlighted [23,24].”
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“Controlled trials in general practices have shown that MI is an effective strategy in the treatment of various diseases [26-30].”
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Huibers, M., Beurskens, A., Bleijenberg, G., & van Schayck, C. (2007) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd003494.pub2 · Cited by 65
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“In some interventions [27, 28 ] an agenda setting chart was used to select a lifestyle topic that a patient was ready to discuss.”
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“Similar issues have been found in other studies (Pill et al. 1998, MacGregor et al. 2006).”
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“approaches have included information or education-based initiatives targeted at patients and/or carers to improve stroke knowledge [22,23]; providing education or training to clinicians to improve communication of secondary prevention advice [16]; and development of new clinical roles such as nurse-coordinators to lia…”
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Linden, A., Butterworth, S. W., & Roberts, N. E. (2006) · Disease Management · doi:10.1089/dis.2006.9.73 · Cited by 33
“50,51 54 As Figure 4 illustrates, the practitioner or coach emphasizes the three underlying assumptions of MI (ie, collaboration, the evoca-tive element, autonomy) in order to establish rapport, reduce resistance, and elicit “change talk” (ie, one’s own reasons and arguments for change).”
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National Standards for Diabetes Self-Management Education
Mensing, C. R., Boucher, J. L., Cypress, M., Weinger, K., Mulcahy, K., Barta, P., Hosey, G. M., Kopher, W., Lasichak, A., Lamb, B., et al. (2003) · Diabetes Care · doi:10.2337/diacare.26.2007.s149 · Cited by 32
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Risk management after stroke: The limits of a patient-centred approach
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“Studies investigating the impact of interventions aimed at improving risk management through retraining health professionals’ communication strategies have had limited success (Kinmonth et al. 1998, Pill et al. 1998).”
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Anderson, B. J. (2003) · Current Diabetes Reports · doi:10.1007/s11892-003-0037-6 · Cited by 25
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Metadata
- Authors
- Pill, R.
- Affiliations
- University of Wales (GB)
- Corresponding author
- Pill, R
- Venue
- Family Practice
- Publisher
- Oxford University Press (OUP)
- Published
- 1998-06-01
- Volume
- 15
- Issue
- 3
- Pages
- 229-235
- ISSN
- 0263-2136 (ISSN-L)
- 1460-2229
- OpenAlex
- W2035471619
- Cited by
- 140
- References
- 0
- Citations by year
- 2023: 3 · 2020: 2 · 2019: 3 · 2018: 2 · 2017: 6 · 2016: 2 · 2015: 4 · 2014: 4 · 2013: 3 · 2012: 4
- FWCI
- 3.96
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Family Practice (publishedVersion)
- PubMed (publishedVersion)
- ORCA Online Research @Cardiff (Cardiff University) (submittedVersion)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
- Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
- Health Sciences › Medicine › Family Practice › Primary Care and Health Outcomes
- Keywords
- type 2 diabetes, general practice, patient-centered interventions, general practitioners, practice nurses, glycosylated haemoglobin, patient satisfaction, functional status, continuing medical education, diabetes care quality
- MeSH terms
- Adult, Aged, Diabetes Mellitus, Type 2, Education, Medical, Continuing, Family Practice, Female, Glycated Hemoglobin, Humans, Male, Middle Aged, Nurse Practitioners, Outcome and Process Assessment, Health Care, Professional-Patient Relations, Health Behavior, Patient Satisfaction, Patient-Centered Care
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