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A Cluster Randomized Trial Comparing Strategies for Translating Self-Management Support into Primary Care Practices
W Perry Dickinson1, L Miriam Dickinson2, Bonnie T Jortberg2
1From the Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO (WPD, LMD, BTJ, DHF, MC); Department of Family and Community Medicine, University of California-San Francisco, San Francisco, CA (DMH, LF). perry.dickinson@ucdenver.edu.
Summary
Interactive behavior-change technology and practice facilitation significantly improved diabetes self-management support activities and patient outcomes. These strategies enhance the adoption of self-management support in primary care settings.
Area of Science:
- Diabetes Care
- Primary Care Implementation Science
- Health Technology Adoption
Background:
- Self-management support (SMS) is crucial for diabetes care but adoption in primary care is limited.
- Interactive behavior-change technology (IBCT) offers efficient methods for SMS implementation.
- Practice facilitation aids in adopting complex evidence-based interventions like SMS.
Purpose of the Study:
- To evaluate the impact of practice education, the Connection to Health (CTH) IBCT tool, and practice facilitation on SMS translation for diabetes patients.
- To assess the incremental effects of these implementation strategies in primary care.
Main Methods:
- A cluster-randomized trial involving 36 primary care practices.
- Three implementation strategies were compared: SMS education (SMS-ED), SMS-ED + CTH, and SMS-ED + CTH + practice facilitation (PF).
- Outcomes included HbA1c levels and SMS activities assessed via medical record reviews at 18 months.
Main Results:
- Patients using CTH with facilitation (CTH + PF) showed improved HbA1c trajectories (P=.0422).
- SMS activities significantly increased in CTH and CTH + PF arms compared to SMS-ED (P=.0223 and P=.0013).
- CTH's impact on SMS activities mediated the intervention's effect on HbA1c.
Conclusions:
- An IBCT tool like CTH can enhance primary care SMS activities and patient HbA1c levels.
- Brief practice facilitation is effective in supporting SMS implementation.
- Combining IBCT with facilitation optimizes diabetes self-management support in primary care.
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