The Patient Activation through Community Empowerment/Engagement for Diabetes Management (PACE-D) protocol: a non-randomised controlled trial of personalised care and support planning for persons living with diabetes

Wee Hian Tan,Meena Sundram,Yii Jen Lew,Shoon Thai Choong,Brent Gibbons,E Shyong Tai,Keith Tsou,Kavita Venkataraman,Vikki Entwistle,Victor Weng Keong Loh,Soon Guan Tan,Doris Young,Tong Wei Yew

doi:10.1186/s12875-020-01173-2

Wee Hian Tan, Meena Sundram + Show 11 more

Open Access

https://doi.org/10.1186/s12875-020-01173-2

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Abstract

BackgroundPersonalised care and support planning (CSP) has been shown to improve diabetes outcomes, patient experience and provider morale in the care of persons living with diabetes. However, this has not been confirmed in controlled studies. Patient Activation through Community Empowerment/Engagement for Diabetes Management (PACE-D) is a pragmatic controlled trial that evaluates the effectiveness of personalised CSP in persons living with diabetes in the public primary care setting in Singapore.MethodsTeamlet-empanelled patients with diabetes at four polyclinics are recruited for this study. Participants who attend either of the two Intervention clinics are sent their investigation results in a care planning letter (CPL) to prepare them for the CSP conversation. This conversation is facilitated by a trained CSP practitioner who engages them in discussion of concerns, goals and action plans, and documents their plans for subsequent review. Participants in the two Control clinics will receive standard diabetes care. Participants will complete two or more CSP conversations (Intervention) or regular consultations (Control) at the annual review visits within the 18 months of the study. The sample size is calculated at 1620 participants, with glycated haemoglobin (HbA1c) as the primary outcome measure. Secondary outcome measures include patient activation (as measured by PAM-13) and changes in healthcare utilisation and cost.DiscussionThis study is a pragmatic trial that evaluates the effectiveness of personalised CSP in persons living with diabetes in a real world setting. It promises to provide insights with regard to the implementation of this model of care in Singapore and the region.Trial registrationClinicalTrials.gov Identifier NCT04288362. Retrospectively registered on 28 February 2020.

Highlights

Personalised care and support planning (CSP) has been shown to improve diabetes outcomes, patient experience and provider morale in the care of persons living with diabetes
This paper describes the design and significance of PACE-D, a pragmatic controlled trial that evaluates the effectiveness of personalised CSP in persons living with diabetes in the public primary care setting in Singapore
Primary objective The primary objective of this study is to examine the effects of personalised CSP (Intervention) compared to the standard model of care (Control) on glycaemic control, as measured by Glycated Haemoglobin (HbA1c)

Summary

Introduction

Personalised care and support planning (CSP) has been shown to improve diabetes outcomes, patient experience and provider morale in the care of persons living with diabetes. This has not been confirmed in controlled studies. Healthcare cost-wise, USD 1.9 billion will be spent on diabetes in 2050 compared to USD 790 million in 2010 [7]. In response to these projections, Singapore declared a nationwide, long-term “war on diabetes” in 2016 [8]. Support for active self-management of persons living with diabetes was identified as a key focus of the campaign [5]

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