Research Unit for General Practice U N I V E R S I T Y OF A A R H U S Department of General Practice A practice nurse addressed intervention to enhance self-management in people with type 2 diabetes By Lise Juul, RN, MPH, Ph.D student Supervisors: Annelli Sandbaek, Helle Terkildsen Maindal, Vibeke Zoffmann

Research Unit for General Practice U N I V E R S I T Y OF A A R H U S Department of General Practice An upcoming intervention study  Main activity:  A training course for practice nurses with autonomy support as the core component carried out in an implementation strategy  Why train practice nurses?  Why autonomy support?  A patientcentered approach  Crucial for motivation  Why in an implementation strategy?

Research Unit for General Practice U N I V E R S I T Y OF A A R H U S Department of General Practice Aim  To implement and evaluate the effect of a nurse-led proactive support to enhance self-management in people with type 2 diabetes in general practice 1) implementation of autonomy supportive communication in nurse-consultations with patients with type 2 diabetes 2) effect-evaluation of the intervention on difference in patientoutcomes 3) association between effect of the intervention and education- level, gender and age? 4) association between attendance to proactive nurse- consultations uptil 3 months after invitation and education- level, gender and age?

Research Unit for General Practice U N I V E R S I T Y OF A A R H U S Department of General Practice Program Theory Inspired by Rossi, et al. Evaluation. A Systematic Approach. 2004

Research Unit for General Practice U N I V E R S I T Y OF A A R H U S Department of General Practice Inputs  General practices with nurses with experience in having consultations with patients with type 2 diabetes  Competent teachers  Tools to guide the autonomy supportive process  Patients with type 2 diabetes, identified in ”Aarhus Diabetes Database”, and validated by the GPs

Research Unit for General Practice U N I V E R S I T Y OF A A R H U S Department of General Practice Activities  A training course for practice nurses with autonomy support as the core component carried out in an implementation strategy

Research Unit for General Practice U N I V E R S I T Y OF A A R H U S Department of General Practice Content of the training course  evidencebased treatment of type 2 diabetes  barriers and facilitators of health behaviour change  communication techniques  introduction of tools to guide the autonomy supportive process

Research Unit for General Practice U N I V E R S I T Y OF A A R H U S Department of General Practice Implementation strategy  interactive educational meetings (4x4 hours over 6 months)  reminder and support by a linkage agent (3 telephone calls over 12 months)

Research Unit for General Practice U N I V E R S I T Y OF A A R H U S Department of General Practice Activities  A training course for practice nurses with autonomy support as the core component carried out in an implementation strategy  Patients will be invited to consultations with the nurse

Research Unit for General Practice U N I V E R S I T Y OF A A R H U S Department of General Practice Outputs  Nurses attend the course  Patients attend the consultations  Accept and use of the tools recommended in the course

Research Unit for General Practice U N I V E R S I T Y OF A A R H U S Department of General Practice Initial outcomes  Patients  reflect about living with diabetes  in the framework of recommended diabetes care, identify goals that are meningful for them  take action to meet them

Research Unit for General Practice U N I V E R S I T Y OF A A R H U S Department of General Practice Intermediate outcomes  Improved health behaviour, e.g.  more compliant to pharmalogical treatment  more physically active  more appropriate diet  smoking cessation  improved control (blood- and visiontests)

Research Unit for General Practice U N I V E R S I T Y OF A A R H U S Department of General Practice Longer-Term outcomes  Improved HbA1c-values  Improved Total-cholesterol-values Less  Improved blood pressure Complications  Weight loss  Less perceived problems in relation to diabetes  Improved quality of life

Research Unit for General Practice U N I V E R S I T Y OF A A R H U S Department of General Practice Design & studypopulation  Cluster randomized controlled trial  30 general practices from the former county of Aarhus - nurses  About 1200 patients with type 2 diabetes - age 40-70

Research Unit for General Practice U N I V E R S I T Y OF A A R H U S Department of General Practice Follow-up  All patients will be followed 15 months  The invitations will be send over a 3 month-period within each practice

Research Unit for General Practice U N I V E R S I T Y OF A A R H U S Department of General Practice Main points  An upcoming intervention study:  A training course for practice nurses with autonomy support as the core component carried out in an implementation strategy  Improved chance of behaviour change and maintenance if the behaviour is felt self chosen and meaningful.

Research Unit for General Practice U N I V E R S I T Y OF A A R H U S Department of General Practice Thank you