Adapting Diabetes Shared Medical Appointments to Fit Context for Practice-Based Research (PBR)
Adapting Diabetes Shared Medical Appointments to Fit Context for Practice-Based Research (PBR)
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DOI：
10.3122/jabfm.2020.05.200049
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发表时间：
2020-09-01
影响因子：
2.9
通讯作者：
Waxmonsky, Jeanette A.
中科院分区：
文献类型：
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作者：
Kwan, Bethany M.;Rementer, Jenny;Waxmonsky, Jeanette A.
复杂的行为干预措施，如糖尿病共享医疗预约（SMAs）应该在实用的试验中进行测试。传播和实施科学家与基于实践的研究网络之间的伙伴关系可以支持适应和实施，以确保这些干预措施符合具体情况。本文描述了适应和实施疾病管理针对性培训（TTIM）干预，以适应初级保健糖尿病的情况。方法：“投资于糖尿病”实用试验采用22个基于实践的研究网络实践，比较两种基于TTIM的糖尿病sma模型。我们使用调查、访谈和观察来评估实践环境因素，如实践规模、地点、付款人组合、变化和工作文化、参与动机以及临床和管理能力。增强型有效项目复制框架用于指导对TTIM的适应和参与实践的实施。结果：实践在规模和患者人口统计学上各不相同。所有的实践都整合了行为健康，但缺乏健康教育工作者或处方提供者。对SMA交付的适应适应了人员灵活性和减少调度负担的需要。对TTIM内容的调整旨在适应一般初级保健糖尿病和讲西班牙语的患者。结论：增强型复制有效方案是一种有用的流程框架，可用于糖尿病初级保健中SMAs的适应、实施和测试。调整干预内容、交付和培训以适应上下文可以帮助确保实用试验具有内部和外部有效性。关注适合背景的干预措施可以支持持续的实践参与研究和以证据为基础的干预措施的可持续性。
Introduction: Complex behavioral interventions such as diabetes shared medical appointments (SMAs) should be tested in pragmatic trials. Partnerships between dissemination and implementation scientists and practice-based research networks can support adaptation and implementation to ensure such interventions fit the context. This article describes adaptations to and implementation of the Targeted Training in Illness Management (TTIM) intervention to fit the primary care diabetes context.Methods: The Invested in Diabetes pragmatic trial engaged 22 practice-based research network practices to compare 2 models of diabetes SMAs, based on TTIM. We used surveys, interviews, and observation to assess practice contextual factors, such as practice size, location, payer mix, change and work culture, motivation to participate, and clinical and administrative capacity. The enhanced Replicating Effective Programs framework was used to guide adaptations to TTIM and implementation in participating practices.Results: Practices varied in size and patient demographics. All practices had integrated behavioral health, but limited health educators or prescribing providers. Adaptations to SMA delivery accommodated the need for flexibility in personnel and reduced scheduling burden. Adaptations to TTIM content were designed to fit general primary care diabetes and Spanish-speaking patients.Conclusion: Enhanced Replicating Effective Programs is a useful process framework for adaptation, implementation, and testing of diabetes SMAs in primary care. Adapting intervention content, delivery, and training to fit context can help ensure pragmatic trials have both internal and external validity. Attention to intervention fit to context can support continued practice engagement in research and sustainability of evidence-based interventions.