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Randomized Controlled Trial
. 2013 Sep 18:347:f5272.
doi: 10.1136/bmj.f5272.

Effectiveness of general practice based, practice nurse led telephone coaching on glycaemic control of type 2 diabetes: the Patient Engagement and Coaching for Health (PEACH) pragmatic cluster randomised controlled trial

Irene D Blackberry  1 , John S Furler, James D Best, Patty Chondros, Margarite Vale, Christine Walker, Trisha Dunning, Leonie Segal, James Dunbar, Ralph Audehm, Danny Liew, Doris Young
Affiliations
Randomized Controlled Trial

Effectiveness of general practice based, practice nurse led telephone coaching on glycaemic control of type 2 diabetes: the Patient Engagement and Coaching for Health (PEACH) pragmatic cluster randomised controlled trial

Irene D Blackberry et al. BMJ. .

Abstract

Objective: To evaluate the effectiveness of goal focused telephone coaching by practice nurses in improving glycaemic control in patients with type 2 diabetes in Australia.

Design: Prospective, cluster randomised controlled trial, with general practices as the unit of randomisation.

Setting: General practices in Victoria, Australia.

Participants: 59 of 69 general practices that agreed to participate recruited sufficient patients and were randomised. Of 829 patients with type 2 diabetes (glycated haemoglobin (HbA1c) >7.5% in the past 12 months) who were assessed for eligibility, 473 (236 from 30 intervention practices and 237 from 29 control practices) agreed to participate.

Intervention: Practice nurses from intervention practices received two days of training in a telephone coaching programme, which aimed to deliver eight telephone and one face to face coaching episodes per patient.

Main outcome measures: The primary end point was mean absolute change in HbA1c between baseline and 18 months in the intervention group compared with the control group.

Results: The intervention and control patients were similar at baseline. None of the practices dropped out over the study period; however, patient attrition rates were 5% in each group (11/236 and 11/237 in the intervention and control group, respectively). The median number of coaching sessions received by the 236 intervention patients was 3 (interquartile range 1-5), of which 25% (58/236) did not receive any coaching sessions. At 18 months' follow-up the effect on glycaemic control did not differ significantly (mean difference 0.02, 95% confidence interval -0.20 to 0.24, P=0.84) between the intervention and control groups, adjusted for HbA1c measured at baseline and the clustering. Other biochemical and clinical outcomes were similar in both groups.

Conclusions: A practice nurse led telephone coaching intervention implemented in the real world primary care setting produced comparable outcomes to usual primary care in Australia. The addition of a goal focused coaching role onto the ongoing generalist role of a practice nurse without prescribing rights was found to be ineffective.

Trial registration: Current Controlled Trials ISRCTN50662837.

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Conflict of interest statement

Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare that: IDB, JSF, and PC received fellowship support from the Australian National Health and Medical Research Council Centre of Clinical Research Excellence in Diabetes for the submitted work; IDB, CW, PC, and MV received support from the National Health and Medical Research Council research grant for the submitted work; MV was the founder of The COACH Program; other authors have no relationships with any companies that might have an interest in the submitted work in the previous three years; DL and RA had financial relationships with pharmaceutical industries outside the submitted work; TD received royalties from a diabetes book and is a board member of the International Diabetes Federation and Diabetes Australia Victoria (voluntary capacity); and other authors have no non-financial interests that may be relevant to the submitted work.

Figures

None
Flow of practices and patients through study
See this image and copyright information in PMC

References

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