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

Sytske van Bruggen*, Marise J. Kasteleyn, Simone P. Rauh, Julia S. Meijer, Karin J.G. Busch, Mattijs E. Numans, Niels H. Chavannes

*Corresponding author for this work

Research output: Contribution to JournalArticleAcademicpeer-review

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 interventionsA focus on patient preferences, team collaboration and intervention feasibility was associated with high implementation fidelityQuantitative: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.

Original languageEnglish
Article number1218
Pages (from-to)1-15
Number of pages15
JournalBMC health services research
Volume21
Early online date9 Nov 2021
DOIs
Publication statusPublished - Dec 2021

Bibliographical note

Funding Information:
The authors thank the practices and patients of the Hadoks care group for their participation in this study.

Publisher Copyright:
© 2021, The Author(s).

Keywords

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

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