Adapting Diabetes Shared Medical Appointments to Fit Context for Practice-Based Research (PBR)
| Autor: | Jeanette A. Waxmonsky, Bethany M. Kwan, Donald E. Nease, Phoutdavone Phimphasone-Brady, Martha Sajatovic, Jenny Rementer, Andrea Nederveld, Natalie Richie |
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| Rok vydání: | 2020 |
| Předmět: |
Medical education
Clinical Trials as Topic Primary Health Care business.industry 030503 health policy & services Comparative effectiveness research Public Health Environmental and Occupational Health Psychological intervention Flexibility (personality) Context (language use) Evidence-based medicine Mental health External validity 03 medical and health sciences 0302 clinical medicine Intervention (counseling) Diabetes Mellitus Medicine Humans Shared Medical Appointments 030212 general & internal medicine 0305 other medical science Family Practice business |
| Zdroj: | Journal of the American Board of Family Medicine : JABFM. 33(5) |
| ISSN: | 1558-7118 |
| Popis: | Introduction: Complex behavioral interventions such as diabetes shared medical appointments (SMAs) should be tested in pragmatic trials. Partnerships between dissemination and implementation scientists and practice-based research networks can support adaptation and implementation to ensure such interventions fit the context. This article describes adaptations to and implementation of the Targeted Training in Illness Management (TTIM) intervention to fit the primary care diabetes context. Methods: The Invested in Diabetes pragmatic trial engaged 22 practice-based research network practices to compare 2 models of diabetes SMAs, based on TTIM. We used surveys, interviews, and observation to assess practice contextual factors, such as practice size, location, payer mix, change and work culture, motivation to participate, and clinical and administrative capacity. The enhanced Replicating Effective Programs framework was used to guide adaptations to TTIM and implementation in participating practices. Results: Practices varied in size and patient demographics. All practices had integrated behavioral health, but limited health educators or prescribing providers. Adaptations to SMA delivery accommodated the need for flexibility in personnel and reduced scheduling burden. Adaptations to TTIM content were designed to fit general primary care diabetes and Spanish-speaking patients. Conclusion: Enhanced Replicating Effective Programs is a useful process framework for adaptation, implementation, and testing of diabetes SMAs in primary care. Adapting intervention content, delivery, and training to fit context can help ensure pragmatic trials have both internal and external validity. Attention to intervention fit to context can support continued practice engagement in research and sustainability of evidence-based interventions. |
| Databáze: | OpenAIRE |
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