Cited by 474Diabetes Management and EducationPatient-Provider Communication in HealthcarePrimary Care and Health Outcomes

Randomised controlled trial of patient centred care of diabetes in general practice: impact on current wellbeing and future disease risk

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Kinmonth, A. L., Woodcock, A., Griffin, S., Spiegal, N., Campbell, M. J·1998·BMJ

Abstract

OBJECTIVE: To assess the effect of additional training of practice nurses and general practitioners in patient centred care on the lifestyle and psychological and physiological status of patients with newly diagnosed type 2 diabetes. DESIGN: Pragmatic parallel group design, with randomisation between practice teams to routine care (comparison group) or routine care plus additional training (intervention group); analysis at one year, allowing for practice effects and stratifiers; self reporting by patients on communication with practitioners, satisfaction with treatment, style of care, and lifestyle. SETTING: 41 practices (21 in intervention group, 20 in comparison group) in a health region in southern England. SUBJECTS: 250/360 patients (aged 30-70 years) diagnosed with type 2 diabetes and completing follow up at one year (142 in intervention group, 108 in comparison group). INTERVENTION: 1.5 days' group training for the doctors and nurses-introducing evidence for and skills of patient centred care and a patient held booklet encouraging questions. MAIN OUTCOME MEASURES: Quality of life, wellbeing, haemoglobin A1c and lipid concentrations, blood pressure, body mass index (kg/m2). RESULTS: Compared with patients in the C group, those in the intervention group reported better communication with the doctors (odds ratio 2.8; 95% confidence interval 1.8 to 4.3) and greater treatment satisfaction (1.6; 1.1 to 2.5) and wellbeing (difference in means (d) 2.8; 0.4 to 5.2). However, their body mass index was significantly higher (d=2.0; 0.3 to 3.8), as were triglyceride concentrations (d=0.4 mmol/l; 0.07 to 0.73 mmol/l), whereas knowledge scores were lower (d=-2.74; -0.23 to -5.25). Differences in lifestyle and glycaemic control were not significant. CONCLUSIONS: The findings suggest greater attention to the consultation process than to preventive care among trained practitioners; those committed to achieving the benefits of patient centred consulting should not lose the focus on disease management.

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  • The study was designed to have 90% power to detect a difference of 0.5% in A1C levels, using a two-sample t test (two-sided, α = 0.05), assuming a common SD of 1.5%; 408 patients were required.

    “The study was designed to have a 90% power to detect a difference of 0.5% in A1C levels. This was determined using a two-sample t test (two-sided, α = 0.05), assuming a common SD of 1.5%. The estimate of SD in A1C values was inflated from 1.15 to 1.50 because of the clustering effect (18,19). We required a total of 408 patients (204 per study arm) to achieve the specified statistical power.”

    From Structured Self-Monitoring of Blood Glucose Significantly Reduces A1C Levels in Poorly Controlled, Noninsulin-Treated Type 2 Diabetes (2011) · cites this paper as [19]

    The Statistical analysis and sample size section gives different design figures: 80% power, 100 patients per group, and detection of a 1% haemoglobin A1c difference with an SD of 2.22%. These contradict the attributed 90% power, 0.5% difference, 1.5% SD, and 408-patient requirement. The cited passage does not specify a two-sample t test. (LLM, conf=0.93)

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  • Only five out of the 22 cluster-randomized studies had the ICC reported.

    “Notably, only five (Chenoweth 2009; Kennedy 2004; Kinmonth 1998; Krones 2008; Loh 2007) out of the 22 studies had the ICC reported.”
  • In Kinmonth 1998, patients in the intervention group were more likely to report maximum communication with GPs.

    “In Kinmonth 1998, patients in the intervention group were more likely to report maximum communication with GPs; but there was no significant difference between the two groups for agreement between patient and provider on main concerns discussed over the year.”
  • All five studies that measured consultation process outcomes reported at least one consultation process outcome in favour of the intervention.

    “and all of these (Brown 2001; Glasgow 2004; Kinmonth 1998; Krones 2008; Loh 2007) reported at least one consultation process outcome in favour of the intervention.”
  • In Kinmonth 1998, there was no significant difference between groups for agreement between patient and provider on main concerns discussed over the year.

    “In Kinmonth 1998, patients in the intervention group were more likely to report maximum communication with GPs; but there was no significant difference between the two groups for agreement between patient and provider on main concerns discussed over the year.”

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Cites

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Research works printed but not linked: 2

  1. Woodcock A, Kinmonth AL, Campbell M, Griffin S, Spiegal N. Effects of training in patient-centred care, on beliefs, attitudes and behaviour of pri- mary care practitioners. Patient Education and Counseling (in press).
  2. Green LW, George MA, Daniel M, Frankish CJ, Herbert CP, Bowie, WR, et al. Study of participatory research in health promotion: review and recommenda- tions for the development of participatory research in health promotion in Canada. Ottawa: Royal Society of Canada, 1995.

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Authors
Kinmonth, A. L., Woodcock, A., Griffin, S., Spiegal, N., & Campbell, M. J.
Affiliations
  • University of Southampton (GB)
  • University of Cambridge (GB)
Corresponding author
Kinmonth, A. L.
Venue
BMJ
Publisher
BMJ
Published
1998-10-31
Volume
317
Issue
7167
Pages
1202-1208
ISSN
  • 0007-1447 (ISSN-L)
  • 0959-8138
  • 1468-5833
OpenAlex
W2124794946
Cited by
474
References
32
Citations by year
2026: 4 · 2025: 3 · 2024: 5 · 2023: 7 · 2022: 11 · 2021: 13 · 2020: 10 · 2019: 16 · 2018: 13 · 2017: 14 · 2016: 17 · 2015: 12 · 2014: 20 · 2013: 28 · 2012: 25
FWCI
11.63
Type
journal article
Language
en
Open access
Locations
  • BMJ (publishedVersion)
  • Europe PMC (PubMed Central) (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • HighWire Press Open Archive (submittedVersion)
Funders
Wellcome Trust
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
  • Health Sciences › Health Professions › General Health Professions › Patient-Provider Communication in Healthcare
  • Health Sciences › Health Professions › General Health Professions › Primary Care and Health Outcomes
Keywords
patient-centered care, type 2 diabetes, newly diagnosed diabetes, general practice, general practice training, patient communication, treatment satisfaction, quality of life, well-being, glycemic control, HbA1c, lipid concentration, blood pressure, body mass index, lifestyle, disease risk
MeSH terms
Adult, Aged, Communication, Diabetes Mellitus, Type 2, England, Family Practice, Health Status, Humans, Life Style, Mental Health, Middle Aged, Nurse Practitioners, Nurse-Patient Relations, Physician-Patient Relations, Treatment Outcome, Patient Satisfaction, Risk Assessment, Patient-Centered Care

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