Abstract
ObjectiveTo examine the effect on cardiovascular (CVD) risk factors of interventions to alter consultations between practitioners and patients with type 2 diabetes.Search StrategyElectronic and manual citation searching to identify relevant randomized controlled trials (RCTs).Inclusion Criteria RCTs that compared usual care to interventions to alter consultations between practitioners and patients. The population was adults aged over 18 years with type 2 diabetes. Trials were set in primary care.Data extraction and synthesisWe recorded if explicit theory‐based interventions were used, how consultations were measured to determine whether interventions had an effect on these and calculated weighted mean differences for CVD risk factors including glycated haemoglobin (HbA1c), systolic blood pressure (SBP), diastolic blood pressure (DBP), total cholesterol (TC), LDL cholesterol (LDL‐C) and HDL cholesterol (HDL‐C).ResultsWe included seven RCTs with a total of 2277 patients with type 2 diabetes. A range of measures of the consultation was reported, and underlying theory to explain intervention processes was generally undeveloped and poorly applied. There were no overall effects on CVD risk factors; however, trials were heterogeneous. Subgroup analysis suggested some benefit among studies in which interventions demonstrated impact on consultations; statistically significant reductions in HbA1c levels (weighted mean difference, −0.53%; 95% CI: [−0.77, −0.28]; P<.0001; I 2=46%).ConclusionsEvidence of effect on CVD risk factors from interventions to alter consultations between practitioners and patients with type 2 diabetes was heterogeneous and inconclusive. This could be explained by variable impact of interventions on consultations. More research is required that includes robust measures of the consultations and better development of theory to elucidate mechanisms.
Highlights
| METHODSThe processes by which patients and their practitioners interact during consultations are a potentially important modifiable context for optimizing the delivery of health care
In subgroup analyses to explore heterogeneity, we found that interventions with measurable impact on the consultation were associated with reduced HbA1c levels and a trend towards reduced blood pressure levels which did not reach statistical significance: systolic blood pressure (SBP) and diastolic blood pressure (DBP). (Figure 3)
This review provides some evidence of the potential of the consultation in primary care to improve CVD risk factors
Summary
The processes by which patients and their practitioners interact during consultations are a potentially important modifiable context for optimizing the delivery of health care. Instead of altering elements of the traditional face-to-face consultation model, interventions seemed to run parallel to these in order to augment the consultation This was observed in more recent trials that included type 2 diabetes patients working with case managers,[18] dieticians[20] or diabetes educators,[13] as well as group education sessions[20] or sharing medical records with patients through web-based care.[18] In the newer studies, we observed a greater move towards multidisciplinarity and multisystem redesign aiming to enable patients and empower them to alter the consultation with the practitioner. Age and HbA1c reported as means unless stated. aIndicates data reported as medians
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