Intensification to injectable therapy in type 2 diabetes: mixed methods study (protocol).
Diabetes mellitus, type 2
Electronic health records
Focus groups
General practice
Glucagon-like peptide-1 receptor
Insulin
Medical record systems, computerized
Patients
Qualitative research
Surveys and questionnaires
Journal
BMC health services research
ISSN: 1472-6963
Titre abrégé: BMC Health Serv Res
Pays: England
ID NLM: 101088677
Informations de publication
Date de publication:
03 May 2019
03 May 2019
Historique:
received:
03
09
2018
accepted:
22
04
2019
entrez:
5
5
2019
pubmed:
6
5
2019
medline:
23
7
2019
Statut:
epublish
Résumé
In the UK, type 2 diabetes mellitus (T2D) is largely managed in primary care. Delay in the intensification to injectable therapy, a form of clinical inertia, is associated with worse glycaemic control. UK general practice is highly computerised, with care being recorded on computerised medical record systems; this allows for quantitative analysis of clinical care but not of the underpinning decision-making process. The aim of this study is to investigate perceptions of patients and clinicians in primary care on the initiation of injectable therapies in T2D, and the context within which those decisions are made. This is a mixed methods study, taking a "realist evaluation" approach. The qualitative components comprise focus groups, interviews, and video recordings of simulated surgeries; the quantitative analysis: an overview of participating practices, elements of the video recording, and an online survey. We will recruit primary care clinicians (general practitioners and nurses) and patients from a representative sample of practices within the Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC) network. Participants will be patients with T2D, and primary care clinicians. Focus groups and semi-structured interviews will be recorded, transcribed verbatim and analysed using Framework Analysis. The simulated surgeries will include cases that might be escalated to injectable therapy. The consultation will be reviewed using the Calgary-Cambridge model to assess communication and determination of adherence to national prescribing guidelines. We will conduct multi-channel video recording including screen capture, clinician and patient facial expressions, wide angle view of the consultation, and the computerised medical record screen. This allows annotation and qualitative analysis of the video recordings, and statistical analyses for the quantitative data. We will also conduct an online survey of primary care clinicians' attitudes to, and perceptions of, initiation of injectable therapies, which will be analysed using summary statistics. Results aim to provide a detailed insight into the dynamic two-way decision-making process underpinning use of injectable therapy for T2D. The study will provide insights into clinical practice and enable the development of training, interventions and guidelines that may facilitate, where appropriate, the intensification to injectable therapy.
Sections du résumé
BACKGROUND
BACKGROUND
In the UK, type 2 diabetes mellitus (T2D) is largely managed in primary care. Delay in the intensification to injectable therapy, a form of clinical inertia, is associated with worse glycaemic control. UK general practice is highly computerised, with care being recorded on computerised medical record systems; this allows for quantitative analysis of clinical care but not of the underpinning decision-making process. The aim of this study is to investigate perceptions of patients and clinicians in primary care on the initiation of injectable therapies in T2D, and the context within which those decisions are made.
METHODS
METHODS
This is a mixed methods study, taking a "realist evaluation" approach. The qualitative components comprise focus groups, interviews, and video recordings of simulated surgeries; the quantitative analysis: an overview of participating practices, elements of the video recording, and an online survey. We will recruit primary care clinicians (general practitioners and nurses) and patients from a representative sample of practices within the Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC) network. Participants will be patients with T2D, and primary care clinicians. Focus groups and semi-structured interviews will be recorded, transcribed verbatim and analysed using Framework Analysis. The simulated surgeries will include cases that might be escalated to injectable therapy. The consultation will be reviewed using the Calgary-Cambridge model to assess communication and determination of adherence to national prescribing guidelines. We will conduct multi-channel video recording including screen capture, clinician and patient facial expressions, wide angle view of the consultation, and the computerised medical record screen. This allows annotation and qualitative analysis of the video recordings, and statistical analyses for the quantitative data. We will also conduct an online survey of primary care clinicians' attitudes to, and perceptions of, initiation of injectable therapies, which will be analysed using summary statistics.
DISCUSSION
CONCLUSIONS
Results aim to provide a detailed insight into the dynamic two-way decision-making process underpinning use of injectable therapy for T2D. The study will provide insights into clinical practice and enable the development of training, interventions and guidelines that may facilitate, where appropriate, the intensification to injectable therapy.
Identifiants
pubmed: 31053136
doi: 10.1186/s12913-019-4112-3
pii: 10.1186/s12913-019-4112-3
pmc: PMC6499968
doi:
Substances chimiques
Blood Glucose
0
Hypoglycemic Agents
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
284Références
Qual Health Res. 1998 May;8(3):362-76
pubmed: 10558337
Diabetes Care. 2000 Apr;23 Suppl 2:B5-10
pubmed: 10860184
Inform Prim Care. 2005;13(1):65-70
pubmed: 15949178
Diabetologia. 1991 Dec;34(12):877-90
pubmed: 1778353
Int J Qual Health Care. 2007 Dec;19(6):349-57
pubmed: 17872937
J Adv Nurs. 2008 Apr;62(2):228-37
pubmed: 18394035
N Engl J Med. 2008 Jun 12;358(24):2560-72
pubmed: 18539916
N Engl J Med. 2008 Jun 12;358(24):2545-59
pubmed: 18539917
N Engl J Med. 2008 Oct 9;359(15):1577-89
pubmed: 18784090
J Med Internet Res. 2008 Sep 08;10(4):e27
pubmed: 18812313
BMJ. 2008 Sep 29;337:a1655
pubmed: 18824488
N Engl J Med. 2009 Jan 8;360(2):129-39
pubmed: 19092145
Diabetes Care. 2010 Jan;33 Suppl 1:S62-9
pubmed: 20042775
BMJ. 2010 Jan 08;340:b4909
pubmed: 20061358
Diabetes Care. 2010 Apr;33(4):733-5
pubmed: 20086256
Lancet. 2010 Feb 6;375(9713):481-9
pubmed: 20110121
Prim Care Diabetes. 2010 Jul;4(2):73-8
pubmed: 20363200
Diabet Med. 2010 Mar;27(3):354-9
pubmed: 20536500
Lancet. 2010 Jun 26;375(9733):2215-22
pubmed: 20609967
Int J Nurs Stud. 2011 Oct;48(10):1234-43
pubmed: 21459380
Diabetes. 2011 Jul;60(7):1856-8
pubmed: 21709281
BMJ. 2012 Jan 10;344:d7771
pubmed: 22236411
CMAJ. 2012 Apr 17;184(7):767-76
pubmed: 22470171
Br J Health Psychol. 2013 Feb;18(1):45-65
pubmed: 22536840
Diabetes Metab. 2012 Mar;38 Suppl 3:S53-8
pubmed: 22541603
J Am Med Inform Assoc. 2013 Jun;20(e1):e67-75
pubmed: 23242763
Diabetes Care. 2013 Sep;36(9):2628-38
pubmed: 23628621
BMC Med Res Methodol. 2013 Sep 18;13:117
pubmed: 24047204
Adm Policy Ment Health. 2015 Sep;42(5):533-44
pubmed: 24193818
Diabetes Care. 2014;37(1):9-16
pubmed: 24356592
Diabetes Care. 2014 Jan;37 Suppl 1:S14-80
pubmed: 24357209
BMJ Open. 2014 Mar 06;4(3):e004339
pubmed: 24604483
Diabetes Technol Ther. 2014 Nov;16(11):768-70
pubmed: 24892463
Diabetes Res Clin Pract. 2014 Sep;105(3):302-12
pubmed: 24956964
J Multidiscip Healthc. 2014 Aug 11;7:355-63
pubmed: 25143743
BMC Fam Pract. 2014 Aug 21;15:144
pubmed: 25145469
Diabet Med. 2015 Mar;32(3):407-13
pubmed: 25251768
Diabetes Care. 2015 Jan;38(1):140-9
pubmed: 25538310
Med Sci Monit. 2015 Feb 05;21:403-11
pubmed: 25652941
Diabetes Metab Syndr Obes. 2015 Jan 16;8:49-56
pubmed: 25653546
J Am Board Fam Med. 2015 May-Jun;28(3):299-302
pubmed: 25957359
Yearb Med Inform. 2015 Aug 13;10(1):22-9
pubmed: 26123905
Malawi Med J. 2015 Mar;27(1):13-5
pubmed: 26137192
Trials. 2015 Oct 20;16:473
pubmed: 26482231
BMJ Open. 2016 Jan 04;6(1):e009905
pubmed: 26729392
Diabetes Obes Metab. 2016 Apr;18(4):401-9
pubmed: 26743666
J Innov Health Inform. 2016 Jan 19;22(4):426-32
pubmed: 26855276
BMJ. 2016 Apr 06;353:i1575
pubmed: 27052837
BMJ Open. 2016 Apr 20;6(4):e011092
pubmed: 27098827
Prim Care Diabetes. 2017 Feb;11(1):3-12
pubmed: 27727005
Yearb Med Inform. 2016 Nov 10;(1):138-145
pubmed: 27830242
Br J Gen Pract. 2017 Jan;67(654):e49-e56
pubmed: 27872084
J Med Internet Res. 2016 Nov 25;18(11):e310
pubmed: 27888169
Lancet. 2017 Jun 3;389(10085):2239-2251
pubmed: 28190580
Prim Care Diabetes. 2017 Apr;11(2):105-106
pubmed: 28222959
Diabetes Care. 2017 Oct;40(10):1289-1297
pubmed: 28798086
Br J Gen Pract. 2017 Oct;67(663):440-441
pubmed: 28963401
Yearb Med Inform. 2018 Aug;27(1):156-162
pubmed: 29681044
Circulation. 1979 Jan;59(1):8-13
pubmed: 758126
BMJ. 1995 Jul 29;311(7000):299-302
pubmed: 7633241
BMJ. 1995 Aug 5;311(7001):376-80
pubmed: 7640549
Med Educ. 1996 Mar;30(2):83-9
pubmed: 8736242
BMJ. 1998 Aug 8;317(7155):359-60
pubmed: 9694745
Lancet. 1998 Sep 12;352(9131):837-53
pubmed: 9742976