Discussing Weight Management With Type 2 Diabetes Patients in Primary Care Using the Small Talk Big Difference Intervention: Protocol for a Randomized Controlled Trial
Discussing Weight Management With Type 2 Diabetes Patients in Primary Care Using the Small Talk Big Difference Intervention: Protocol for a Randomized Controlled Trial
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DOI：
10.2196/12162
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发表时间：
2019-02-01
影响因子：
1.7
通讯作者：
Logue, Jennifer
中科院分区：
文献类型：
--
作者：
Brooksbank, Katriona;O'Donnell, Joanne;Logue, Jennifer
背景资料：2型糖尿病管理指南普遍建议为2型糖尿病和肥胖的成年人提供个性化干预措施，以鼓励减肥。然而，尽管有现有的建议，体重管理服务的提供目前在英国各地是不完整的，在服务可用的地方，经常报告高流失率。此外，个人往往未能接受服务，即在与全科医生或执业护士讨论后，个人被转介到该服务，但没有参加预约。定性研究已经确定，最初的讨论提出的问题的重量，激励病人，并提到服务是至关重要的一个成功的结果从体重management.Objective：我们的目的是评估的有效性，基于互联网的培训计划和实践实施工具包，或没有面对面的培训初级保健工作人员。主要结果是干预前后3个月2型糖尿病患者转介到国民健康服务成人体重管理项目的比例变化。我们使用行为改变轮为初级保健工作人员制定了一项干预措施，包括一个1小时的基于互联网的电子学习包，涵盖肥胖、2型糖尿病和体重管理的益处之间的联系，肥胖患者的糖尿病治疗，提出体重问题的具体培训，当地服务和转诊途径，体重管理组成部分/证据库概述，以及减肥者的作用。该软件包还包括一本患者小册子，一个讨论工具，一个实践实施清单，以及一个可选的2.5小时的面对面培训课程。我们以1：1的比例随机分配了100个实践，要么立即访问所有资源，要么延迟4个月访问。将进行意向治疗统计分析。结果：研究招募现已完成。我们将在2018年完成随访，并在2019年初发表。结论：本方案描述了干预措施的有效性的开发和随机评估，以提高2型糖尿病成人体重管理计划的转诊率和接受率。当许多新的饮食和药物体重管理干预措施显示出对2型糖尿病患者的巨大临床益处时，初级保健医生愿意，熟练并且能够讨论体重并适当地转诊服务至关重要。
Background: Guidelines for the management of type 2 diabetes universally recommend that adults with type 2 diabetes and obesity be offered individualized interventions to encourage weight loss. Yet despite the existing recommendations, provision of weight management services is currently patchy around the United Kingdom and where services are available, high attrition rates are often reported. In addition, individuals often fail to take up services, that is, after discussion with a general practitioner or practice nurse, individuals are referred to the service but do not attend for an appointment. Qualitative research has identified that the initial discussion raising the issue of weight, motivating the patient, and referring to services is crucial to a successful outcome from weight management.Objective: Our aim was to evaluate the effectiveness of an Internet-based training program and practice implementation toolkit with or without face-to-face training for primary care staff. The primary outcome is the change in referral rate of patients with type 2 diabetes to National Health Service adult weight management programs, 3 months pre-and postintervention.Methods: We used the Behavior Change Wheel to develop an intervention for staff in primary care consisting of a 1-hour Internet-based eLearning package covering the links between obesity, type 2 diabetes, and the benefits of weight management, the treatment of diabetes in patients with obesity, specific training in raising the issue of weight, local services and referral pathways, overview of weight management components/evidence base, and the role of the referrer. The package also includes a patient pamphlet, a discussion tool, a practice implementation checklist, and an optional 2.5-hour face-to-face training session. We have randomly assigned 100 practices in a 1:1 ratio to either have immediate access to all the resources or have access delayed for 4 months. An intention-to-treat statistical analysis will be performed.Results: Recruitment to the study is now complete. We will finalize follow-up in 2018 and publish in early 2019.Conclusions: This protocol describes the development and randomized evaluation of the effectiveness of an intervention to improve referral and uptake rates of weight management programs for adults with type 2 diabetes. At a time when many new dietary and pharmacological weight management interventions are showing large clinical benefits for people with type 2 diabetes, it is vital that primary care practitioners are willing, skilled, and able to discuss weight and make appropriate referrals to services.