Family Practice, Vol 15, 229-235, Copyright © 1998 by World Organization of Family Doctors
R Pill, NC Stott, SR Rollnick and M Rees
AIM: Our objective was to evaluate the effect of training in a patient-
centred intervention for GPs and practice nurses on outcomes for patients
with Type II diabetes. METHODS: We carried out a randomized controlled
trial within general practices as the basis for randomization and a
before-and-after design for measures of patient outcome. A parallel process
study examined the use of the method by professionals. The study was
carried out in 29 general practices in South Glamorgan who had participated
for at least 2 years in a local scheme of audit and CME in relation to Type
II diabetes care. The subjects were 252 Type II diabetic patients recruited
by 15 experimental and 14 control practices. The main outcome measures were
changes in glycosylated haemoglobin, patient satisfaction with care and
treatment, functional health status and professional ability to apply the
intervention. RESULTS: Professionals adopted the innovative method with
enthusiasm, but after 2 years only 19% continued to apply the method
systematically. The trial was, therefore, unable to demonstrate significant
biochemical or functional improvements. This highlights the need to
understand the factors associated with professional uptake and subsequent
ability to sustain changes in behaviour. CONCLUSIONS: The efficacy of this
behavioural intervention remains unproved, despite its acceptability to
professional staff. Detailed and prolonged development and testing of
behavioural interventions is an essential first step before embarking on
randomized controlled trials which involve complex behavioural changes in
professionals or patients.
ORIGINAL CLINICAL RESEARCH
A randomized controlled trial of an intervention designed to improve the care given in general practice to Type II diabetic patients: patient outcomes and professional ability to change behaviour
Department of General Practice, University of Wales College of Medicine, Health Centre, Llanedeyrn, Cardiff, UK.
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