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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.

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a practice nurse addressed intervention to enhance self management in people with type 2 diabetes

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

an upcoming intervention study
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

slide3
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 education-

level, gender and age?

4) association between attendance to proactive nurse-

consultations uptil 3 months after invitation and education-

level, gender and age?

Department of General Practice

program theory
Program Theory

Inspired by Rossi, et al. Evaluation. A Systematic Approach. 2004

Department of General Practice

inputs
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

activities
Activities
  • A training course for practice nurses with autonomy support as the core component carried out in an implementation strategy

Department of General Practice

content of the training course
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

implementation strategy
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

activities9
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

outputs
Outputs
  • Nurses attend the course
  • Patients attend the consultations
  • Accept and use of the tools recommended in the course

Department of General Practice

initial outcomes
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

intermediate outcomes
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

longer term outcomes
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

design studypopulation
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

follow up
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

main points
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

thank you
Thank you

Department of General Practice