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

Bruggen, S. van; Kasteleyn, M.J.; Rauh, S.P.; Meijer, J.S.; Busch, K.J.G.; Numans, M.E.; Chavannes, N.H. (2021)

Article / Letter to editor

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 ( = 4), dispensing with protocol encouraged reflection on tailored care and selection of various self-management interventions nA focus on patient preferences, team collaboration and intervention feasibility was associated with high implementation fidelity Quantitative: In patients ( = 126), likelihood of complete monitoring decreased significantly after two years (OR 0.2 (95% CI 0.1-0.5), < 0.001) npSatisfaction decreased slightly (- 1.6 (95% CI -2.6;-0.6), = 0.001) pNon-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.

• Tailoring of diabetes care
• Successful implementation of self-management
• Patient experiences

• All authors: Bruggen, S. van; Kasteleyn, M.J.; Rauh, S.P.; Meijer, J.S.; Busch, K.J.G.; Numans, M.E.; Chavannes, N.H.
• Date: 2021-11-09
• Journal: BMC Health Services Research
• Volume: 21
• Issue: 1
• DOI: doi:10.1186/s12913-021-07198-2
• Link: https://bmchealthservres.biomedcentral.com/track/pdf/10.1186/s12913-021-...