Re-Think the Strip: de-implementing a low value practice in primary care

Katrina E Donahue^{1

2}, Marcella H Boynton³, Jennifer Leeman⁴, Jennifer Rees⁵, Erica Richman⁶, Kathleen Mottus⁵, Lisa P Spees⁷, Maihan B Vu⁸, April B Reese⁹, Hazel Tapp¹⁰, Adam Lee⁵, Asia Johnson¹¹, Rebecca J Cleveland¹², Laura A Young¹³

Affiliations

¹ Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. kdonahue@med.unc.edu.
² UNC-CH Department of Family Medicine, 590 Manning Dr, Chapel Hill, NC, 27599, USA. kdonahue@med.unc.edu.
³ Department of Medicine, Division of General Medicine & Clinical Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
⁴ School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
⁵ North Carolina Translational and Clinical Sciences Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
⁶ Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
⁷ Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
⁸ Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
⁹ Diabetes Team, National Association of Chronic Disease Directors, Raleigh, NC, USA.
¹⁰ Department of Family Medicine, Atrium Health, Charlotte, NC, USA.
¹¹ Cooperative Studies Program Epidemiology Center, Veteran Affairs Health Care System, Durham, NC, USA.
¹² Division of Rheumatology, Allergy and Immunology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
¹³ Department of Medicine, Division of Endocrinology and Metabolism, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.

PMID: 40186094
PMCID: PMC11969945
DOI: 10.1186/s12875-025-02781-6

Re-Think the Strip: de-implementing a low value practice in primary care

Katrina E Donahue et al. BMC Prim Care. 2025.

. 2025 Apr 4;26(1):96.

doi: 10.1186/s12875-025-02781-6.

Authors

Affiliations

¹ Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. kdonahue@med.unc.edu.
² UNC-CH Department of Family Medicine, 590 Manning Dr, Chapel Hill, NC, 27599, USA. kdonahue@med.unc.edu.
³ Department of Medicine, Division of General Medicine & Clinical Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
⁴ School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
⁵ North Carolina Translational and Clinical Sciences Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
⁶ Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
⁷ Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
⁸ Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
⁹ Diabetes Team, National Association of Chronic Disease Directors, Raleigh, NC, USA.
¹⁰ Department of Family Medicine, Atrium Health, Charlotte, NC, USA.
¹¹ Cooperative Studies Program Epidemiology Center, Veteran Affairs Health Care System, Durham, NC, USA.
¹² Division of Rheumatology, Allergy and Immunology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
¹³ Department of Medicine, Division of Endocrinology and Metabolism, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.

PMID: 40186094
PMCID: PMC11969945
DOI: 10.1186/s12875-025-02781-6

Abstract

Background: Self-monitoring of blood glucose (SMBG) is a low value health care practice that does not benefit most patients with non-insulin treated type 2 diabetes (T2DM). This paper evaluates Re-Think the Strip (RTS), a multi-component study aimed at de-implementing SMBG among non-insulin treated T2DM patients in primary care.

Methods: This study used a pre-post design to evaluate the effectiveness and implementation of Re-Think the Strip in 20 primary care clinics with a comparison group of 34 clinics within one health system. De-implementation strategies were implemented over 12 months and practices were followed for 18 months.

Results: There was an overall decrease in the odds of receiving a prescription for diabetes testing supplies (i.e., test strips and/or lancets) between the baseline and 12-month intervention follow-up for intervention and comparison clinics (OR 0.96, 95% CI 0.94, 0.98). However, there was no statistically significant difference in prescribing between the intervention and comparison clinics. In sensitivity analyses, a small intervention effect was observed for those patients newly diagnosed with T2DM or newly assigned to a study clinic (OR = 0.97, 95% CI 0.95, 1.00).

Conclusions: De-implementation strategies are feasible in primary care practices. Although prescriptions for SMBG decreased in intervention practices, they also decreased in the comparison practices. Newly diagnosed patients or new patients may be more receptive to de-implementation. Other factors, including the COVID-19 pandemic and baseline prescribing rates may have limited the effectiveness of the RTS de-implementation strategy.

Keywords: De-implementation; Diabetes; Glucose monitoring; Implementation and dissemination; Practice-based research.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: All study procedures were approved by the UNC Institutional Review Board (#18-3319). Informed consent was obtained from all human subjects involved this study. All methods were carried out in accordance with relevant guidelines and regulations or declaration of Helsinki. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

**Fig. 1**
Predicted probabilities⁺ for strip/lancet Rx, 12- and 18-months for Original and New Patient Cohorts a. 12months b. 18months *New = patients new to the practice or newly diagnosed with T2DM ⁺Predicted probabilities are the same as unadjusted predicted proportions

See this image and copyright information in PMC

References

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Re-Think the Strip: de-implementing a low value practice in primary care

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Re-Think the Strip: de-implementing a low value practice in primary care

Authors

Affiliations

Abstract

Conflict of interest statement

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References

MeSH terms

Grants and funding

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Full Text Sources

Medical