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Doris Young, John Furler, Christine Walker, Margarite Vale, James Best, Leonie Segal, Trisha Dunning
(NHMRC GP clinical research grant July 2005-8)
PEACH: Patient Engagement And Coaching for Health an intensive intervention for patients with Type
2 Diabetes
Background
Treatment gap worse for disadvantaged communities, less likely to see GPs and specialists, lower rates of lipid testing
Good evidence from clinical trials that intensive treatment interventions reduce biological risk factors and reduce morbidity/mortality *
(*Gaede et al. Multifactorial intervention and cardiovascular disease in patients with type 2 diabetes: N.Engl J Med. 2003; 348: 383-93)
Hypothesis
Supporting patients with poorly controlled T2D through individual coaching by existing practice nurses in GP clinics will improve process of care and health outcomes compared with usual GP care and this approach will be cost effective
Aim
To determine the effectiveness of a patient focused method for chronic disease self management (COACH program) in order to achieve intensive treatment goals for T2D in a GP setting
PEACH study flowchart
InterventionUsual GP care + COACH program
ControlUsual GP care
Follow-up assessments at 12 and 18 months
Recruit eligible participants
Appointment with PN Explain study Obtain consent Baseline data collection
Inclusion Criteria Type 2 diabetes patients >18yrs HbA1c>7.5%
Mail out from Practices
Optional follow-up phone calls by PN
Second mail out from Practices
Exclusion Criteria No phone number Other complex debilitating medical condition
Generate list of up to 40 eligible patients from each Practice
Randomise Practices
Primary Outcome
Change in HbA1c level from baseline to 12 and 18 months post-randomisation in the intervention group compared with the control group
Secondary Outcomes
BP, BMI, waistSmoking cessation (urinary cotinine at 18 months)Diabetes self efficacyQuality of Life (AQOL)Depression screeningHospitalisation and health service utilisation
Process of GP care, blood testsDiabetes, anti-HT,statin, aspirinTC, TG, LDL, HDLUrinary albuminPhysical activity and Diet
What’s in it for the practice?
• Training the PN to identify diabetes patient population
• Reimbursement for PN participation• Chance to access free diabetes education for
the PN• COACH training for those involved in the
intervention group• Paid 2 hr briefing session
What’s in it for the PN?
• Increased knowledge of diabetes• Expand your role• Expand your research skills• Certificate pf participation• CPD points• Free COACH training in the intervention group• Free COACH training to all if it proves
successful
What’s in it for the GP?
• Improving care and health outcomes• Support in care planning and annual cycles of
care• QA&CPD points• Detailed feedback on patients• Research training for interested GP’s
Prof Doris Young, Principal Investigator,
Dept of GP, The University of Melbourne,200 Berkeley St, Carlton VIC 3053Email: [email protected]
www.peach.unimelb.edu.au
PEACH: Patient Engagement And Coaching for Health an intensive intervention for patients with Type
2 Diabetes
