The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
BMC Fam Pract. 2014 Apr 9;15:65. doi: 10.1186/1471-2296-15-65.
The Danish health care sector is reorganising based on disease management programmes designed to secure integrated and high quality chronic care across hospitals, general practitioners and municipalities. The disease management programmes assign a central role to general practice; and in the Capital Region of Denmark a facilitator-based intervention was undertaken to support the implementation of the programmes in general practice. The purpose of the study was to assess the effectiveness of this semi-tailored facilitator-based intervention.
The study was a stepped-wedge, randomised, controlled trial among general practices in the Capital Region of Denmark. The intervention group was offered three one-hour visits by a facilitator. The intervention was semi-tailored to the perceived needs as defined by each general practice, and the practices could choose from a list of possible topics. The control group was a delayed intervention group. The primary outcome was change in the number of annual chronic disease check-ups. Secondary outcomes were: changes in the number of annual check-ups for type 2 diabetes (DM2) and chronic obstructive pulmonary disease (COPD); changes in the number of spirometry tests, changes in the use of ICPC diagnosis coding and patient stratification; sign-up for a software program for patient overview; and reduction in number of practices with few annual chronic disease check-ups.
We randomised 189 general practices: 96 practices were allocated to the intervention group and 93 to the delayed intervention group. For the primary outcome, 94 and 89 practices were analysed. Almost every outcome improved from baseline to follow-up in both allocation groups. At follow-up there was no difference between allocation groups for the primary outcome (p = 0.1639). However, some secondary outcomes favoured the intervention: a higher reported use of ICPC diagnosis coding for DM2 and COPD (p = 0.0050, p = 0.0243 respectively), stratification for COPD (p = 0.0185) and a faster initial sign-up rate for the software program.
The mixed results from this study indicate that a semi-tailored facilitator-based intervention of relatively low intensity is unlikely to add substantially to the implementation of disease management programmes for DM2 and COPD in a context marked by important concurrent initiatives (including financial incentives and mandatory registry participation) aimed at moving all practices towards changes in chronic care.
ClinicalTrials.gov: NCT01297075.
丹麦医疗保健部门正在根据疾病管理计划进行重组，旨在确保医院、全科医生和市辖区之间的慢性疾病的整合和高质量的护理。这些疾病管理计划赋予了全科医生核心角色；在丹麦首都地区，开展了以促进者为基础的干预，以支持这些计划在全科医生中的实施。本研究旨在评估这种半定制的以促进者为基础的干预的有效性。
这是一项在丹麦首都地区的全科医生中开展的分步式、随机、对照试验。干预组接受了三次由促进者进行的一个小时的访问。该干预是根据每个全科医生所定义的感知需求进行半定制的，并且这些实践可以从可能的主题列表中进行选择。对照组为延迟干预组。主要结果是每年进行慢性疾病检查的次数的变化。次要结果是：2 型糖尿病（DM2）和慢性阻塞性肺疾病（COPD）的年度检查次数的变化；肺功能检查次数的变化，ICPC 诊断编码和患者分层的使用变化；注册使用患者概览软件程序；以及每年进行慢性疾病检查次数较少的实践数量减少。
我们随机分配了 189 个全科医生实践：96 个实践被分配到干预组，93 个实践被分配到延迟干预组。对于主要结果，有 94 个和 89 个实践进行了分析。在两个分配组中，几乎所有结果都从基线到随访期间都有所改善。在随访时，两组之间在主要结果方面没有差异（p = 0.1639）。然而，一些次要结果有利于干预组：DM2 和 COPD 的 ICPC 诊断编码使用报告更高（p = 0.0050，p = 0.0243），COPD 的分层（p = 0.0185）以及软件程序的初始注册速度更快。
本研究的混合结果表明，在以重要的并行举措（包括财务激励和强制性登记参与）为标志的情况下，针对 2 型糖尿病和慢性阻塞性肺疾病实施疾病管理计划时，相对低强度的半定制的以促进者为基础的干预不太可能显著增加。这些举措旨在推动所有实践朝着慢性疾病护理的变化发展。
ClinicalTrials.gov：NCT01297075。
