Effectiveness of general practice based, practice nurse led telephone coaching on glycaemic control of type 2 diabetes: the patient engagement and coaching for health (peach) pragmatic cluster randomised controlled trial
Open accessAbstract
OBJECTIVE: To evaluate the effectiveness of goal focused telephone coaching by practice nurses in improving glycaemic control in patients with type 2 diabetes in Australia. DESIGN: Prospective, cluster randomised controlled trial, with general practices as the unit of randomisation. SETTING: General practices in Victoria, Australia. PARTICIPANTS: 59 of 69 general practices that agreed to participate recruited sufficient patients and were randomised. Of 829 patients with type 2 diabetes (glycated haemoglobin (HbA1c) >7.5% in the past 12 months) who were assessed for eligibility, 473 (236 from 30 intervention practices and 237 from 29 control practices) agreed to participate. INTERVENTION: Practice nurses from intervention practices received two days of training in a telephone coaching programme, which aimed to deliver eight telephone and one face to face coaching episodes per patient. MAIN OUTCOME MEASURES: The primary end point was mean absolute change in HbA1c between baseline and 18 months in the intervention group compared with the control group. RESULTS: The intervention and control patients were similar at baseline. None of the practices dropped out over the study period; however, patient attrition rates were 5% in each group (11/236 and 11/237 in the intervention and control group, respectively). The median number of coaching sessions received by the 236 intervention patients was 3 (interquartile range 1-5), of which 25% (58/236) did not receive any coaching sessions. At 18 months' follow-up the effect on glycaemic control did not differ significantly (mean difference 0.02, 95% confidence interval -0.20 to 0.24, P=0.84) between the intervention and control groups, adjusted for HbA1c measured at baseline and the clustering. Other biochemical and clinical outcomes were similar in both groups. CONCLUSIONS: A practice nurse led telephone coaching intervention implemented in the real world primary care setting produced comparable outcomes to usual primary care in Australia. The addition of a goal focused coaching role onto the ongoing generalist role of a practice nurse without prescribing rights was found to be ineffective. TRIAL REGISTRATION: Current Controlled Trials ISRCTN50662837.
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In two studies reporting depression, there were no group differences.
“Two studies reported on depression.14 16 There were no group differences found in these two studies.”
From Effectiveness of synchronous teleconsultation for patients with type 2 diabetes mellitus: a systematic review and meta-analysis (2023) · cites this paper as [16]
A lack of focus on drug-based interventions by practice nurses may be attributed to discomfort or lack of confidence in their ability to interfere with the patient and doctor's current therapeutic management.
“A lack of focus on drug-based interventions by practice nurses may be attributed to discomfort or lack of confidence in their ability to interfere with the patient and doctor’s current therapeutic management.16”
From Effectiveness of synchronous teleconsultation for patients with type 2 diabetes mellitus: a systematic review and meta-analysis (2023) · cites this paper as [16]
In two studies reporting quality of life, both found no difference between groups.
“Two studies reported on quality of life.16 18 Both studies found no difference between groups.”
From Effectiveness of synchronous teleconsultation for patients with type 2 diabetes mellitus: a systematic review and meta-analysis (2023) · cites this paper as [16]
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- Authors
- Blackberry, I. D., Furler, J. S., Best, J. D., Chondros, P., Vale, M., Walker, C., Dunning, T., Segal, L., Dunbar, J., Audehm, R., Liew, D., & Young, D.
- Affiliations
- The University of Melbourne (AU)
- Barwon Health (AU)
- University of South Australia (AU)
- Deakin University (AU)
- The Royal Melbourne Hospital (AU)
- Corresponding author
- Blackberry, I. D.
- ORCID
- Venue
- BMJ
- Publisher
- BMJ
- Published
- 2013-09-18
- Volume
- 347
- Issue
- sep18 1
- Pages
- f5272-f5272
- ISSN
- 1756-1833 (ISSN-L)
- PMC
- PMC3776648
- OpenAlex
- W2021416630
- Cited by
- 113
- References
- 65
- Citations by year
- 2026: 6 · 2025: 6 · 2024: 5 · 2023: 10 · 2022: 9 · 2021: 12 · 2020: 5 · 2019: 9 · 2018: 7 · 2017: 12 · 2016: 14 · 2015: 9 · 2014: 6 · 2013: 3
- FWCI
- 8.41
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- cc-by-nc
- Locations
- BMJ (publishedVersion, cc-by-nc)
- Europe PMC (PubMed Central) (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- UniSA Research Outputs Repository (University of South Australia) (submittedVersion, other-oa)
- Deakin Research Online (Deakin University) (submittedVersion)
- Minerva Access (University of Melbourne) (submittedVersion, cc-by-nc)
- Funders
- Medical Research Council
- National Health and Medical Research Council (359374, 566586)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
- Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Keywords
- type 2 diabetes, glycemic control, HbA1c, telephone coaching, practice nurses, primary care, patient engagement, coaching effectiveness, patient dropout
- MeSH terms
- Aged, Communication, Counseling, Diabetes Mellitus, Type 2, Female, Glycated Hemoglobin, Humans, Hyperglycemia, Male, Middle Aged, Nurse-Patient Relations, Telephone, Victoria, Practice Patterns, Nurses', General Practice
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