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Improving Diabetes care through Examining, Advising, and prescribing (IDEA): protocol for a theory-based cluster randomised controlled trial of a multiple behaviour change intervention aimed at primary healthcare professionals

机译:通过检查,建议和处方(IDEA)改善糖尿病护理:针对主要医疗保健专业人员的多种行为改变干预措施的基于理论的集群随机对照试验的方案

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摘要

Abstract Background New clinical research findings may require clinicians to change their behaviour to provide high-quality care to people with type 2 diabetes, likely requiring them to change multiple different clinical behaviours. The present study builds on findings from a UK-wide study of theory-based behavioural and organisational factors associated with prescribing, advising, and examining consistent with high-quality diabetes care. Aim To develop and evaluate the effectiveness and cost of an intervention to improve multiple behaviours in clinicians involved in delivering high-quality care for type 2 diabetes. Design/methods We will conduct a two-armed cluster randomised controlled trial in 44 general practices in the North East of England to evaluate a theory-based behaviour change intervention. We will target improvement in six underperformed clinical behaviours highlighted in quality standards for type 2 diabetes: prescribing for hypertension; prescribing for glycaemic control; providing physical activity advice; providing nutrition advice; providing on-going education; and ensuring that feet have been examined. The primary outcome will be the proportion of patients appropriately prescribed and examined (using anonymised computer records), and advised (using anonymous patient surveys) at 12 months. We will use behaviour change techniques targeting motivational, volitional, and impulsive factors that we have previously demonstrated to be predictive of multiple health professional behaviours involved in high-quality type 2 diabetes care. We will also investigate whether the intervention was delivered as designed (fidelity) by coding audiotaped workshops and interventionist delivery reports, and operated as hypothesised (process evaluation) by analysing responses to theory-based postal questionnaires. In addition, we will conduct post-trial qualitative interviews with practice teams to further inform the process evaluation, and a post-trial economic analysis to estimate the costs of the intervention and cost of service use. Discussion Consistent with UK Medical Research Council guidance and building on previous development research, this pragmatic cluster randomised trial will evaluate the effectiveness of a theory-based complex intervention focusing on changing multiple clinical behaviours to improve quality of diabetes care. Trial registration ISRCTN66498413 .
机译:摘要背景新的临床研究发现可能要求临床医生改变其行为,以便为2型糖尿病患者提供高质量的护理,可能要求他们改变多种不同的临床行为。本研究基于英国范围内与高质量糖尿病护理的处方,咨询和检查相关的基于理论的行为和组织因素研究的结果。目的开发并评估干预措施的有效性和成本,以改善参与为2型糖尿病提供高质量护理的临床医生的多种行为。设计/方法我们将在英格兰东北部的44种常规实践中进行两臂集群随机对照试验,以评估基于理论的行为改变干预措施。我们的目标是改善2型糖尿病质量标准中强调的六种表现不佳的临床行为:高血压处方;规定控制血糖;提供体育锻炼建议;提供营养建议;提供持续的教育;并确保检查脚。主要结果将是在12个月内适当处方和检查(使用匿名计算机记录)并建议(使用匿名患者调查)的患者比例。我们将使用针对动机,自愿和冲动因素的行为改变技术,这些技术以前已经证明可以预测参与高质量2型糖尿病护理的多种健康专业行为。我们还将调查是否通过编码录音带的讲习班和干预主义者的交付报告来按照设计(保真度)交付干预措施,并通过分析对基于理论的邮政调查问卷的回应来进行假设(过程评估)操作。此外,我们将与业务团队进行审后定性访谈,以进一步为过程评估提供信息,并进行审后经济分析,以评估干预成本和服务使用成本。讨论与英国医学研究理事会的指导一致,并以先前的研究为基础,这项实用的整群随机试验将评估基于理论的复杂干预措施的有效性,该干预措施着眼于改变多种临床行为以改善糖尿病护理的质量。试用注册ISRCTN66498413。

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