The Patient Activation through Community Empowerment/Engagement for Diabetes Management (PACE-D) protocol: a non-randomised controlled trial of personalised care and support planning for persons living with diabetes

Wee Hian Tan, Victor Weng Keong Loh, Kavita Venkataraman, Shoon Thai Choong, Yii Jen Lew, Meena Sundram, Keith Tsou, Soon Guan Tan, Brent Gibbons, Vikki Entwistle, Doris Young, E Shyong Tai, Tong Wei Yew, Wee Hian Tan, Victor Weng Keong Loh, Kavita Venkataraman, Shoon Thai Choong, Yii Jen Lew, Meena Sundram, Keith Tsou, Soon Guan Tan, Brent Gibbons, Vikki Entwistle, Doris Young, E Shyong Tai, Tong Wei Yew

Abstract

Background: Personalised care and support planning (CSP) has been shown to improve diabetes outcomes, patient experience and provider morale in the care of persons living with diabetes. However, this has not been confirmed in controlled studies. Patient Activation through Community Empowerment/Engagement for Diabetes Management (PACE-D) is a pragmatic controlled trial that evaluates the effectiveness of personalised CSP in persons living with diabetes in the public primary care setting in Singapore.

Methods: Teamlet-empanelled patients with diabetes at four polyclinics are recruited for this study. Participants who attend either of the two Intervention clinics are sent their investigation results in a care planning letter (CPL) to prepare them for the CSP conversation. This conversation is facilitated by a trained CSP practitioner who engages them in discussion of concerns, goals and action plans, and documents their plans for subsequent review. Participants in the two Control clinics will receive standard diabetes care. Participants will complete two or more CSP conversations (Intervention) or regular consultations (Control) at the annual review visits within the 18 months of the study. The sample size is calculated at 1620 participants, with glycated haemoglobin (HbA1c) as the primary outcome measure. Secondary outcome measures include patient activation (as measured by PAM-13) and changes in healthcare utilisation and cost.

Discussion: This study is a pragmatic trial that evaluates the effectiveness of personalised CSP in persons living with diabetes in a real world setting. It promises to provide insights with regard to the implementation of this model of care in Singapore and the region.

Trial registration: ClinicalTrials.gov Identifier NCT04288362. Retrospectively registered on 28 February 2020.

Keywords: Care and support planning; Diabetes mellitus.; Long term conditions.; Patient activation.; Primary care.; Self-management..

Conflict of interest statement

The authors declare they have no competing interests.

Figures

Fig. 1
Fig. 1
Participant flow in the Patient Activation through Community Empowerment/Engagement for Diabetes Management (PACE-D) study

References

    1. Nanditha A, Ma RCW, Ramachandran A, Snehalatha C, Chan JCN, Chia KS, et al. Diabetes in Asia and the Pacific: implications for the global epidemic. Diabetes Care. 2016;39(3):472–485. doi: 10.2337/dc15-1536.
    1. Rolic G, Varghese C, Riley L, Harvey A, Krug E, Alwan A, et al. WHO Global Report on Diabetes: Executive Summary France: World Health Organization (WHO) 2016.
    1. Ministry of Health (MOH) Singapore . War on Diabetes Summary Report: 2016-2019. Summary report. Singapore: Singapore Ministry of Health (MOH); 2019.
    1. Ministry of Health (MOH) Singapore . Division EDC. Singapore: Ministry of Health (MOH) Singapore; 2011. National Health Survey 2010; p. 200.
    1. Ministry of Health (MOH) Singapore . Executive Summary on National Population Health Survey 2016/17. Singapore: Ministry of Health (MOH), Singapore; 2018. p. 4.
    1. National Registry of Diseases Office (NRDO) Information Paper on Diabetes in Singapore. Singapore: Singapore: Ministry of Health (MOH); 2011. p. 6.
    1. Png ME, Yoong J, Phan TP, Wee HL. Current and future economic burden of diabetes among working-age adults in Asia: conservative estimates for Singapore from 2010-2050. BMC Public Health. 2016;16(1):153–159. doi: 10.1186/s12889-016-2827-1.
    1. Khalik S. Parliament: Health Minister Gan Kim Yong declares 'war on diabetes'; new task force set up. The Straits Times. 2016.
    1. Norris SL, Lau J, Smith SJ, Schmid CH, Engelgau MM. Self-management education for adults with type 2 diabetes: a meta-analysis of the effect on glycemic control. Diabetes Care. 2002;25(7):1159–1171. doi: 10.2337/diacare.25.7.1159.
    1. Reynolds R, Dennis S, Hasan I, Slewa J, Chen W, Tian D, et al. A systematic review of chronic disease management interventions in primary care. BMC Fam Pract. 2018;19(1):11–13. doi: 10.1186/s12875-017-0692-3.
    1. Roberts S, Eaton S, Finch T, Lewis-Barned N, Lhussier M, Oliver L, et al. The year of care approach: developing a model and delivery programme for care and support planning in long term conditions within general practice. BMC Fam Pract. 2019;20(1):153–116. doi: 10.1186/s12875-019-1042-4.
    1. Coulter A, Entwistle VA, Eccles A, Ryan S, Shepperd S, Perera R. Personalised care planning for adults with chronic or long-term health conditions. Cochrane Database Syst Rev. 2015;3:CD010523.
    1. Diabetes UK. Year of Care: Report of findings from the pilot programme. Year of Care, National Health Service (NHS) 2011.
    1. National Health Service (NHS) RCoGPR . The RCGP Curriculum: The Curriculum Topic Guides. Curriculum Topic Guide. London: Royal College of General Practitioners (RCGP); 2019.
    1. Wagner EH, Austin BT, Korff MV. Organizing Care for Patients with chronic illness. Milbank Q. 1996;74(4):511–544. doi: 10.2307/3350391.
    1. Newbould J, Burt J, Bower P, Blakeman T, Kennedy A, Rogers A, et al. Experiences of care planning in England: interviews with patients with long term conditions. BMC Fam Pract. 2012;13(1):71. doi: 10.1186/1471-2296-13-71.
    1. Blakeman T, Macdonald W, Bower P, Gately C, Chew-Graham C. A qualitative study of GPs' attitudes to self-management of chronic disease. Br J Gen Pract. 2006;56(527):407–414.
    1. Stewart M, Brown JB, Weston W, Mcwhinney IR, Mcwilliam CL, Freeman T. Patient-centered medicine: transforming the clinical method. 3. London: Radcliffe Publishing; 2014.
    1. Neighbour R. The inner consultation: how to develop an effective and intuitive consulting style. Lancaster: MTP Press; 1987.
    1. Bandura A. Self-efficacy: toward a unifying theory of behavioral change. Psychol Rev. 1977;84(2):191–215. doi: 10.1037/0033-295X.84.2.191.
    1. Funnell MM, Anderson RM. Empowerment and self-Management of Diabetes. Clin Diabetes. 2004;22(3):123–127. doi: 10.2337/diaclin.22.3.123.
    1. Brown S, Lhussier M, Dalkin SM, Eaton S. Care planning: what works, for whom, and in what circumstances? A rapid realist review. Qual Health Res. 2018;28(14):2250–2266. doi: 10.1177/1049732318768807.
    1. Hibbard JH, Stockard J, Mahoney ER, Tusler M. Development of the Patient Activation Measure (PAM): Conceptualizing and Measuring Activation in Patients and Consumers. Health Serv Res. 2004;39(4p1):1005–1026. doi: 10.1111/j.1475-6773.2004.00269.x.
    1. Bodenheimer T, Willard-Grace R. Teamlets in primary care: enhancing the patient and clinician experience. J Am Board Fam Med. 2016;29(1):135–138. doi: 10.3122/jabfm.2016.01.150176.
    1. Hewitt H, Gafaranga J, McKinstry B. Comparison of face-to-face and telephone consultations in primary care: qualitative analysis. Br J Gen Pract. 2010;60(574):e201–ee12. doi: 10.3399/bjgp10X501831.
    1. Tapp H, Phillips SE, Waxman D, Alexander M, Brown R, Hall M. Multidisciplinary team approach to improved chronic care management for diabetic patients in an urban safety net ambulatory care clinic. J Am Board Fam Med. 2012;25(2):245–246. doi: 10.3122/jabfm.2012.02.110243.
    1. Wetmore S, Boisvert L, Graham E, Hall S, Hartley T, Wright L, et al. Patient satisfaction with access and continuity of care in a multidisciplinary academic family medicine clinic. Can Fam Physician. 2014;60(4):e230–e2e6.
    1. Ministry of Health (MOH) Singapore . Diabetes Mellitus: MOH Clinical Practice Guidelines 1/2014. Singapore: Singapore: Ministry of Health (MOH); 2014.
    1. Ministry of Health (MOH) Singapore. Lipids: MOH Clinical Practice Guidelines 2/2016. Singapore: Ministry of Health (MOH), Singapore; 2016. Available from . 2014;29(8):1166–76.
    1. Hendriks M, Rademakers J. Relationships between patient activation, disease-specific knowledge and health outcomes among people with diabetes; a survey study. BMC Health Serv Res. 2014;14(1):393. doi: 10.1186/1472-6963-14-393.
    1. Hendriks SH, Hartog LC, Groenier KH, Maas AH, van Hateren KJ, Kleefstra N, et al. Patient activation in type 2 Diabetes: does it differ between men and women? J Diabetes Res. 2016;2016:7386532. doi: 10.1155/2016/7386532.
    1. Benjamini Y, Hochberg Y. Controlling the false discovery rate: a practical and powerful approach to multiple testing. J R Stat Soc Ser B Methodol. 1995;57(1):289–300.
    1. Burke JF, Sussman JB, Kent DM, Hayward RA. Three simple rules to ensure reasonably credible subgroup analyses. BMJ. 2015;351:1–5.
    1. Weaver CG, Ravani P, Oliver MJ, Austin PC, Quinn RR. Analyzing hospitalization data: potential limitations of Poisson regression. Nephrol Dial Transplant. 2015;30(8):1244–1249. doi: 10.1093/ndt/gfv071.

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