Experiences with tailoring of primary diabetes care in well-organised general practices: a mixed-methods study

Abstract Background Dutch standard diabetes care is generally protocol-driven. However, considering that general practices wish to tailor diabetes care to individual patients and encourage self-management, particularly in light of current COVID-19 related constraints, protocols and other barriers ma...

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Autores principales:	Sytske van Bruggen, Marise J. Kasteleyn, Simone P. Rauh, Julia S. Meijer, Karin J. G. Busch, Mattijs E. Numans, Niels H. Chavannes
Formato:	article
Lenguaje:	EN
Publicado:	BMC 2021
Materias:	Tailoring of diabetes care Successful implementation of self-management Patient experiences Public aspects of medicine RA1-1270
Acceso en línea:	https://doaj.org/article/a45f207f68234112b09fd3588e3b58b9
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spelling	oai:doaj.org-article:a45f207f68234112b09fd3588e3b58b92021-11-14T12:09:58ZExperiences with tailoring of primary diabetes care in well-organised general practices: a mixed-methods study10.1186/s12913-021-07198-21472-6963https://doaj.org/article/a45f207f68234112b09fd3588e3b58b92021-11-01T00:00:00Zhttps://doi.org/10.1186/s12913-021-07198-2https://doaj.org/toc/1472-6963Abstract Background Dutch standard diabetes care is generally protocol-driven. However, considering that general practices wish to tailor diabetes care to individual patients and encourage self-management, particularly in light of current COVID-19 related constraints, protocols and other barriers may hinder implementation. The impact of dispensing with protocol and implementation of self-management interventions on patient monitoring and experiences are not known. This study aims to evaluate tailoring of care by understanding experiences of well-organised practices 1) when dispensing with protocol; 2) determining the key conditions for successful implementation of self-management interventions; and furthermore exploring patients’ experiences regarding dispensing with protocol and self-management interventions. Methods in this mixed-methods prospective study, practices (n = 49) were invited to participate if they met protocol-related quality targets, and their adult patients with well-controlled type 2 diabetes were invited if they had received protocol-based diabetes care for a minimum of 1 year. For practices, study participation consisted of the opportunity to deliver protocol-free diabetes care, with selection and implementation of self-management interventions. For patients, study participation provided exposure to protocol-free diabetes care and self-management interventions. Qualitative outcomes (practices: 5 focus groups, 2 individual interviews) included experiences of dispensing with protocol and the implementation process of self-management interventions, operationalised as implementation fidelity. Quantitative outcomes (patients: routine registry data, surveys) consisted of diabetes monitoring completeness, satisfaction, wellbeing and health status at baseline and follow-up (24 months). Results Qualitative: In participating practices (n = 4), dispensing with protocol encouraged reflection on tailored care and selection of various self-management interventions A focus on patient preferences, team collaboration and intervention feasibility was associated with high implementation fidelity Quantitative: In patients (n = 126), likelihood of complete monitoring decreased significantly after two years (OR 0.2 (95% CI 0.1–0.5), p < 0.001) Satisfaction decreased slightly (− 1.6 (95% CI -2.6;-0.6), p = 0.001) Non-significant declines were found in wellbeing (− 1.3 (95% CI -5.4; 2.9), p = 0.55) and health status (− 3.0 (95% CI -7.1; 1.2), p = 0.16). Conclusions To tailor diabetes care to individual patients within well-organised practices, we recommend dispensing with protocol while maintaining one structural annual monitoring consultation, combined with the well-supported implementation of feasible self-management interventions. Interventions should be selected and delivered with the involvement of patients and should involve population preferences and solid team collaborations.Sytske van BruggenMarise J. KasteleynSimone P. RauhJulia S. MeijerKarin J. G. BuschMattijs E. NumansNiels H. ChavannesBMCarticleTailoring of diabetes careSuccessful implementation of self-managementPatient experiencesPublic aspects of medicineRA1-1270ENBMC Health Services Research, Vol 21, Iss 1, Pp 1-15 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Tailoring of diabetes care Successful implementation of self-management Patient experiences Public aspects of medicine RA1-1270
spellingShingle	Tailoring of diabetes care Successful implementation of self-management Patient experiences Public aspects of medicine RA1-1270 Sytske van Bruggen Marise J. Kasteleyn Simone P. Rauh Julia S. Meijer Karin J. G. Busch Mattijs E. Numans Niels H. Chavannes Experiences with tailoring of primary diabetes care in well-organised general practices: a mixed-methods study
description	Abstract Background Dutch standard diabetes care is generally protocol-driven. However, considering that general practices wish to tailor diabetes care to individual patients and encourage self-management, particularly in light of current COVID-19 related constraints, protocols and other barriers may hinder implementation. The impact of dispensing with protocol and implementation of self-management interventions on patient monitoring and experiences are not known. This study aims to evaluate tailoring of care by understanding experiences of well-organised practices 1) when dispensing with protocol; 2) determining the key conditions for successful implementation of self-management interventions; and furthermore exploring patients’ experiences regarding dispensing with protocol and self-management interventions. Methods in this mixed-methods prospective study, practices (n = 49) were invited to participate if they met protocol-related quality targets, and their adult patients with well-controlled type 2 diabetes were invited if they had received protocol-based diabetes care for a minimum of 1 year. For practices, study participation consisted of the opportunity to deliver protocol-free diabetes care, with selection and implementation of self-management interventions. For patients, study participation provided exposure to protocol-free diabetes care and self-management interventions. Qualitative outcomes (practices: 5 focus groups, 2 individual interviews) included experiences of dispensing with protocol and the implementation process of self-management interventions, operationalised as implementation fidelity. Quantitative outcomes (patients: routine registry data, surveys) consisted of diabetes monitoring completeness, satisfaction, wellbeing and health status at baseline and follow-up (24 months). Results Qualitative: In participating practices (n = 4), dispensing with protocol encouraged reflection on tailored care and selection of various self-management interventions A focus on patient preferences, team collaboration and intervention feasibility was associated with high implementation fidelity Quantitative: In patients (n = 126), likelihood of complete monitoring decreased significantly after two years (OR 0.2 (95% CI 0.1–0.5), p < 0.001) Satisfaction decreased slightly (− 1.6 (95% CI -2.6;-0.6), p = 0.001) Non-significant declines were found in wellbeing (− 1.3 (95% CI -5.4; 2.9), p = 0.55) and health status (− 3.0 (95% CI -7.1; 1.2), p = 0.16). Conclusions To tailor diabetes care to individual patients within well-organised practices, we recommend dispensing with protocol while maintaining one structural annual monitoring consultation, combined with the well-supported implementation of feasible self-management interventions. Interventions should be selected and delivered with the involvement of patients and should involve population preferences and solid team collaborations.
format	article
author	Sytske van Bruggen Marise J. Kasteleyn Simone P. Rauh Julia S. Meijer Karin J. G. Busch Mattijs E. Numans Niels H. Chavannes
author_facet	Sytske van Bruggen Marise J. Kasteleyn Simone P. Rauh Julia S. Meijer Karin J. G. Busch Mattijs E. Numans Niels H. Chavannes
author_sort	Sytske van Bruggen
title	Experiences with tailoring of primary diabetes care in well-organised general practices: a mixed-methods study
title_short	Experiences with tailoring of primary diabetes care in well-organised general practices: a mixed-methods study
title_full	Experiences with tailoring of primary diabetes care in well-organised general practices: a mixed-methods study
title_fullStr	Experiences with tailoring of primary diabetes care in well-organised general practices: a mixed-methods study
title_full_unstemmed	Experiences with tailoring of primary diabetes care in well-organised general practices: a mixed-methods study
title_sort	experiences with tailoring of primary diabetes care in well-organised general practices: a mixed-methods study
publisher	BMC
publishDate	2021
url	https://doaj.org/article/a45f207f68234112b09fd3588e3b58b9
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Experiences with tailoring of primary diabetes care in well-organised general practices: a mixed-methods study

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