Abstract
BackgroundThere is increasing interest in developing peer-led and 'expert patient'-type interventions, particularly to meet the support and informational needs of those with long term conditions, leading to improved clinical outcomes, and pressure relief on mainstream health services. There is also increasing interest in telephone support, due to its greater accessibility and potential availability than face to face provided support. The evidence base for peer telephone interventions is relatively weak, although such services are widely available as support lines provided by user groups and other charitable services.Methods/DesignIn a 3-arm RCT, participants are allocated to either an intervention group with Telecare service provided by a Diabetes Specialist Nurse (DSN), an intervention group with service provided by a peer supporter (also living with diabetes), or a control group receiving routine care only. All supporters underwent a 2-day training in motivational interviewing, empowerment and active listening skills to provide telephone support over a period of up to 6 months to adults with poorly controlled type 2 diabetes who had been recommended a change in diabetes management (i.e. medication and/or lifestyle changes) by their general practitioner (GP). The primary outcome is self-efficacy; secondary outcomes include HbA1c, total and HDL cholesterol, blood pressure, body mass index, and adherence to treatment. 375 participants (125 in each arm) were sought from GP practices across West Midlands, to detect a difference in self-efficacy scores with an effect size of 0.35, 80% power, and 5% significance level. Adults living with type 2 diabetes, with an HbA1c > 8% and not taking insulin were initially eligible. A protocol change 10 months into the recruitment resulted in a change of eligibility by reducing HbA1c to > 7.4%. Several qualitative studies are being conducted alongside the main RCT to describe patient, telecare supporter and practice nurse experience of the trial.Discussion and implications of the researchWith its focus on self-management and telephone peer support, the intervention being trialled has the potential to support improved self-efficacy and patient experience, improved clinical outcomes and a reduction in diabetes-related complications.Trial RegistrationCurrent Controlled Trials, ISRCTN63151946
Highlights
There is increasing interest in developing peer-led and 'expert patient'-type interventions, to meet the support and informational needs of those with long term conditions, leading to improved clinical outcomes, and pressure relief on mainstream health services
Interviewees reported that telephone support is often provided from secondary care by diabetes specialist nurses (DSN) when patients are first changed to insulin, the short-term nature of this support meant that it had limited effectiveness in assisting patients with the long-term physical and psychological difficulties of treatment change
The project, in light of its focus upon self-management, peer involvement and telephone support has the potential to demonstrate an approach that is relevant to realising progress towards the achievement of the care targets in relation to diabetes, but a range of long term conditions
Summary
Numerous studies have reported the relationship between self-management practice for long term conditions, patient behavioural change and subsequent improvement in physical and psychological well being and reduction in health service resource use [1,2]. Interviewees reported that telephone support is often provided from secondary care by diabetes specialist nurses (DSN) when patients are first changed to insulin, the short-term nature of this support meant that it had limited effectiveness in assisting patients with the long-term physical and psychological difficulties of treatment change. Expert opinion was sought through the Warwick Diabetes Care Advisory Board, a group of nationally recognised experts of various disciplines related to diabetes care, chaired by Professor Harry Keen This strongly endorsed the use of peer supporters to advise patients, in light of their knowledge of the current inadequacies in care provision, in particular relation to the ever increasing pressure being placed upon DSNs within secondary care. Obtain clinical data as a means to identifying patterns and trends to be used in conjunction with behavioural change outcomes, in order to determine the value of undertaking a full scale RCT of the cost and clinical effectiveness of the intervention
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