A practice nurse addressed intervention to enhance self-management in people with type 2 diabetes
By Lise Juul, RN, MPH, Ph.D student Supervisors: Annelli Sandbaek, Helle Terkildsen Maindal, Vibeke Zoffmann
Department of General Practice
Research Unit for General Practice
U N I V E R S I T Y OF A A R H U S
An upcoming intervention study
Main activity: A training course for practice nurses with autonomy support as the core component carried out in an implementation strategy
Why train practice nurses? Why autonomy support?
A patientcentered approach Crucial for motivation
Why in an implementation strategy?
Department of General Practice
Research Unit for General Practice
U N I V E R S I T Y OF A A R H U S
Aim
To implement and evaluate the effect of a nurse-led proactive support to enhance self-management in people with type 2 diabetes in general practice
1) implementation of autonomy supportive communication in nurse-consultations with patients with type 2 diabetes 2) effect-evaluation of the intervention on difference in patientoutcomes 3) association between effect of the intervention and educationlevel, gender and age? 4) association between attendance to proactive nurseconsultations uptil 3 months after invitation and educationlevel, gender and age?
Department of General Practice
Research Unit for General Practice
U N I V E R S I T Y OF A A R H U S
Program Theory
Outcomes Intermediate
Improved health behaviour (e.g. more compliant in pharmalogical treatment, more physicaly active, more appropriate food consumption, smoking cessation, improved control (blood- and visiontests))
Inputs
Practices with a practice-nurse Teachers Tools to guide the autonomi supportive process Patients with type 2 diabetes identified in "Aarhus Diabetes Database"
Activities
Training of the nurses in an implementation strategi with autonomi support as the core component
Outputs
Nurses attend the course Patients attend the consultations
Initial
Patients reflect about living with diabetes, and in the framework of evidencebased treatment, identify goals that are meaningful for them, and take action to meet them
Longer-Term
Improved HbA1c-values Improved Total-cholesterolvalues Improved blood pressure Weight loss Less perceived problems in relation to diabetes Improved quality of life
Patients will be invited Accept and use of the to consultations with tools recommended in the nurse the course
Practice;
Patient;
Nurses experience in Age doing consultations Gender No. of nurses Education-level Interest of chronic care GP-nurse collaboration Time
Inspired by Rossi, et al. Evaluation. A Systematic Approach. 2004
Department of General Practice
Research Unit for General Practice
U N I V E R S I T Y OF A A R H U S
Inputs
General practices with nurses with experience in having consultations with patients with type 2 diabetes
Competent teachers
Tools to guide the autonomy supportive process
Patients with type 2 diabetes, identified in ”Aarhus Diabetes Database”, and validated by the GPs
Department of General Practice
Research Unit for General Practice
U N I V E R S I T Y OF A A R H U S
Activities
A training course for practice nurses with autonomy support as the core component carried out in an implementation strategy
Department of General Practice
Research Unit for General Practice
U N I V E R S I T Y OF A A R H U S
Content of the training course
evidencebased treatment of type 2 diabetes barriers and facilitators of health behaviour change communication techniques introduction of tools to guide the autonomy supportive process
Department of General Practice
Research Unit for General Practice
U N I V E R S I T Y OF A A R H U S
Implementation strategy
interactive educational meetings (4x4 hours over 6 months) reminder and support by a linkage agent (3 telephone calls over 12 months)
Department of General Practice
Research Unit for General Practice
U N I V E R S I T Y OF A A R H U S
Activities
A training course for practice nurses with autonomy support as the core component carried out in an implementation strategy
Patients will be invited to consultations with the nurse
Department of General Practice
Research Unit for General Practice
U N I V E R S I T Y OF A A R H U S
Outputs
Nurses attend the course
Patients attend the consultations Accept and use of the tools recommended in the course
Department of General Practice
Research Unit for General Practice
U N I V E R S I T Y OF A A R H U S
Initial outcomes
Patients
reflect about living with diabetes in the framework of recommended diabetes care, identify goals that are meningful for them take action to meet them
Department of General Practice
Research Unit for General Practice
U N I V E R S I T Y OF A A R H U S
Intermediate outcomes
Improved health behaviour, e.g.
more compliant to pharmalogical treatment more physically active more appropriate diet smoking cessation improved control (blood- and visiontests)
Department of General Practice
Research Unit for General Practice
U N I V E R S I T Y OF A A R H U S
Longer-Term outcomes
Improved HbA1c-values Improved Total-cholesterol-values Less Improved blood pressure Complications Weight loss Less perceived problems in relation to diabetes Improved quality of life
Department of General Practice
Research Unit for General Practice
U N I V E R S I T Y OF A A R H U S
Design & studypopulation
Cluster randomized controlled trial 30 general practices from the former county of Aarhus - nurses
About 1200 patients with type 2 diabetes - age 40-70
Department of General Practice
Research Unit for General Practice
U N I V E R S I T Y OF A A R H U S
Follow-up
All patients will be followed 15 months
The invitations will be send over a 3 month-period within each practice
Department of General Practice
Research Unit for General Practice
U N I V E R S I T Y OF A A R H U S
Main points
An upcoming intervention study: A training course for practice nurses with autonomy support as the core component carried out in an implementation strategy
Improved chance of behaviour change and maintenance if the behaviour is felt self chosen and meaningful.
Department of General Practice
Research Unit for General Practice
U N I V E R S I T Y OF A A R H U S
Thank you
Department of General Practice
Research Unit for General Practice
U N I V E R S I T Y OF A A R H U S