Effectiveness of a Training Course for General Practice Nurses in Motivation Support in Type 2 Diabetes Care: A Cluster-Randomised Trial
| Autor: | Lise Juul, Helle Terkildsen Maindal, Annelli Sandbæk, Morten Frydenberg, Vibeke Zoffmann |
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| Rok vydání: | 2014 |
| Předmět: |
Male
Time Factors Epidemiology Health Care Providers Denmark General Practice Motivational interviewing lcsh:Medicine Nurses Type 2 diabetes law.invention Endocrinology Randomized controlled trial law Surveys and Questionnaires Outcome Assessment Health Care Health care Medicine and Health Sciences Cluster Analysis Public and Occupational Health Registries lcsh:Science Education Nursing education.field_of_study Multidisciplinary Middle Aged Nursing Education Type 2 Diabetes Cholesterol Research Design Female Research Article Adult medicine.medical_specialty Clinical Research Design Population Motivational Interviewing Nursing Research and Analysis Methods Disease cluster Nursing Science Intervention (counseling) Diabetes mellitus Mental Health and Psychiatry Diabetes Mellitus medicine Humans Clinical Trials education Primary Care Aged Diabetic Endocrinology Glycated Hemoglobin Motivation business.industry lcsh:R medicine.disease Health Care Diabetes Mellitus Type 2 Metabolic Disorders Family medicine lcsh:Q Clinical Medicine business Follow-Up Studies Program Evaluation |
| Zdroj: | PLoS ONE Juul, L, Maindal, H T, Zoffmann, V, Frydenberg, M & Sandbaek, A 2014, ' Effectiveness of a training course for general practice nurses in motivation support in type 2 diabetes care : a cluster-randomised trial ', PLOS ONE, vol. 9, no. 5, pp. e96683 . https://doi.org/10.1371/journal.pone.0096683 PLoS ONE, Vol 9, Iss 5, p e96683 (2014) |
| ISSN: | 1932-6203 |
| Popis: | Type 2-diabetes er en udbredt metabolisk lidelse, som kan medføre svære helbredsmæssige komplikationer. Forebyggelse kan forhindre mange følgesygdomme, men kræver ofte en stor indsats fra patientens side. Dette studie undersøgte effektiviteten af et uddannelseskursus for sygeplejersker i almen praksis. Kurset omhandlede, hvordan man inden for de aktuelle rammer for type 2 diabetes behandling kan anvende ”Self-determination Theory, en motivationsteori om underliggende årsager for handlinger. Effektiviteten blev evalueret i et cluster-randomiseret pragmatisk design, der inkluderede 40 danske almen praksis i Aarhus-området, og blev målt blandt deres tilknyttede diabetespopulation (n= 4034) på HbA1c- og totalkolesterolniveauer samt trivsel 18 måneder efter uddannelseskursets start. Resultaterne viser, at uddannelseskurset ikke væsentligt forbedrede HbA1c- og kolesterol-værdierne i interventions¬gruppen. Uddannelseskurset synes heller ikke at have nogen betydelig indvirkning på patienternes generelle velbefindende (målt med PAID og SF-12), men prædefinerede subgruppe-analyser antyder dog, at der muligvis kan være en effekt hos kvinder, hvilket bør undersøges nærmere i fremtidige studier. BACKGROUND: Type 2 diabetes is a common metabolic disease with the potential for prevention of complications. The prevention requires a high level of lasting actions from the patients, which may be burdensome. The aim of this trial was to evaluate the effectiveness of a training course for general practice nurses in motivation support at 18 months follow-up in the affiliated type 2 diabetes population.METHODS: Forty general practices with nurse-led diabetes consultations from the area of Aarhus, Denmark were randomised 1∶1 to either intervention or usual practice. Intervention practices were offered a 16-hour Self-determination theory - based course including communication training for general practice nurses delivered over 10 months. The affiliated diabetes populations (aged 40-74 years) were identified from registers (intervention n = 2,005; usual n = 2,029). Primary outcomes were register-based glycated haemoglobin (HbA1c) -, total cholesterol levels, and well-being measured by the Problem Areas In Diabetes scale (PAID) and the mental component summary score, SF12 (SF12, mcs). Intention-to-treat analyses were performed. Predefined subgroups analyses were performed.RESULTS: The differences between the intervention- and the control practices' mean HbA1c and total cholesterol at follow-up adjusted for baseline values and clustering were respectively: -0.02%-points (95% CI: -0.11 to 0.07; p: 0.67); 0.08 mmol/l (95% CI: 0.01 to 0.15; p: 0.02). Differences in median scores adjusted for clustering were for PAID: 1.25; p = 0.31 and SF12, mcs: 0.99; p = 0.15. Women in intervention practices differed from women in usual practices on mean HbA1c: -0.12%-points (-0.23 to -0.02; p = 0.02) and SF12, mcs: 2.6; p = 0.01.CONCLUSIONS: Offering a training course for general practice nurses in applying the Self-determination theory in current type 2 diabetes care had no effect compared with usual practice measured by HbA1c and total cholesterol levels and the well-being at 18 months of follow-up in a comprehensive register-based diabetes population. Subgroup analyses suggested a possible effect in women, which deserves further attention.TRIAL REGISTRATION: ClinicalTrials.gov (Identifier NCT01187069). |
| Databáze: | OpenAIRE |
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