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Prof. Dr. Attila Altiner 

Universität Rostock

Institut für Allgemeinmedizin

Doberaner Str. 142

18057 Rostock  

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Improvement of the care of poorly controlled patients with diabetes mellitus type 2 (DEBATE)

Anja Wollny, Eva Drewelow (Institut für Allgemeinmedizin, Medizinische Fakultät der Universität Rostock)

 

Summary

In the framework of a multi-centre, cluster-randomised controlled study, the DEBATE project aims to examine the effectiveness of an educational intervention in GP practices for the improvement of GP care of poorly controlled patients with diabetes mellitus type 2 in three study centres.

 

For a considerable number of poorly controlled patients with diabetes mellitus, a situation exists in which both the patient and GP – perfectly aware of the poor control – have resigned themselves and can no longer find new approaches to improve on the ingrained routine. In the framework of the project, therefore, the GP's communication style and the consultation contents should be influenced in a sustainable manner. This includes in particular the fostering of shared decision making, which is associated with a sustainable patient empowerment. To this aim, the intervention uses two implementation strategies which have already been successfully applied in other contexts: Firstly, the motivation-conducive dialogue with a peer (a colleague practicing as a GP), and secondly, the provision of the software-based communication tool arriba, which will be extended to include diabetes-specific aspects at the beginning of the study.

 

In parallel to this, in each of the three study centres Rostock, Düsseldorf and Witten, 20 GPs (total N=60) are recruited who each admit 13 randomly selected patients (total N=780) to the study. The phases of the project are roughly divided into the preparation phase, with the recruitment of the participants, a baseline data collection phase with subsequent randomisation of the participating GPs (into intervention and control group, each with N=30) and of their patients into intervention or control, and building on this, four further data collection phases (T1=6, T2=12, T3=18 T4 = 24 months after the intervention). In the intervention group, GP training sessions are conducted by qualified peers for the change in physicians' communication style to support shared decision making and for the use of a decision aid which was specially developed for this purpose (arriba-diabetes). In the control group, the treatment "care as usual" is given.

 

In the framework of the study, it is examined whether the intervention, aimed at GPs, is in a position to
a) decrease the HbA1c value of the included patients compared to the control group, and

b) increase the patients' share in the decision making.

 

If the care of the patients in the intervention group is relevant and significantly superior to the previous routine care, a theoretically founded training concept to improve GP care of poorly controlled patients with diabetes mellitus type 2 will be available which has been tested for feasibility and acceptance and proven to be effective and efficient.




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