OBJECTIVE -To determine whether Pro-Active Call Center Treatment Support (PACCTS), using trained nonmedical telephonists supported by specially designed software and a diabetes nurse, can effectively improve glycemic control in type 2 diabetes. RESEARCH DESIGN AND METHODS -A randomized controlled implementationtrial of 1-year duration was conducted in Salford, U.K. The trial comprised 591 randomly selected individuals with type 2 diabetes. By random allocation, 197 individuals were assigned to the usual care (control) group and 394 to the PACCTS (intervention) group. Lifestyle advice and drug treatment in both groups followed local guidelines. PACCTS patients were telephoned according to a protocol with the frequency of calls proportional to the last HbA 1c level. The primary outcome was absolute reduction in HbA 1c , and the secondary outcome was the proportion of patients reducing HbA 1c by at least 1%.RESULTS -A total of 332 patients (84%) in the PACCTS group and 176 patients (89%) in the control group completed the study. Final HbA 1c values were available in 374 patients (95%) in the PACCTS group and 180 patients (92%) in the usual care group. Compared with usual care, HbA 1c improved by 0.31% (95% CI 0.11-0.52, P ϭ 0.003) overall in the PACCTS patients. For patients with baseline HbA 1c Ͼ7%, the improvement increased to 0.49% (0.21-0.77, P Ͻ 0.001), whereas in patients with baseline HbA 1c Ͻ7% there was no change. The difference in the proportions of patients achieving a Ն1% reduction in HbA 1c significantly favored the PACCTS intervention: 10% (4 -16, P Ͻ 0.001) overall and 15% (7-24, P Ͻ 0.001) for patients with baseline HbA 1c Ͼ7%.CONCLUSIONS -In an urban Caucasian trial population with blood glucose HbA 1c Ͼ7%, PACCTS facilitated significant improvement in glycemic control. Further research should extend the validity of findings to rural communities and other ethnic groups, as well as to smoking and lipid and blood pressure control. Diabetes Care 28:278 -282, 2005A worldwide epidemic of type 2 diabetes is threatening to overwhelm the capacity of health care service providers. There is good evidence that tight blood glucose, blood pressure, and lipid control can markedly reduce the adverse impact of type 2 diabetes and deliver substantial health benefits (1-4). Reviews of implementation strategies to achieve these treatment targets indicate that a multifaceted approach is most successful (5). Although a stepped-care program based on guidelines, education of primary care professionals, and support from secondary and intermediate care specialists has achieved appreciable improvements in blood pressure and lipid control in the Salford area, it has failed, thus far, to improve blood glucose control (6).Chronic disease management programs seem to be most successful when they support treatment adherence and self-efficacy (7-10). Attaining type 2 diabetes treatment targets requires appreciable pharmacologic intervention (1,3,4). However, good blood glucose control may be particularly difficult because of the s...

OBJECTIVE -To examine patients' views of the acceptability of and satisfaction with telephone care center support provided to improve blood glucose control in type 2 diabetes.RESEARCH DESIGN AND METHODS -The Pro-Active Call-Center Treatment Support (PACCTS) Trial randomized patients from 47 general practices in a deprived urban area in northwest England to usual care or to proactive call center support in addition to usual care. Satisfaction with care was assessed in all 591 patients at baseline and the end of the study using the Diabetes Satisfaction and Treatment Questionnaire (DTSQ). Acceptability was assessed in 394 intervention patients after at least three proactive calls from the call center and at the end of the trial. A purposive sample of 25 patients took part in in-depth semistructured interviews.RESULTS -The response rates to the questionnaires were 79% (DTSQ) and 65% (acceptability). Persons receiving the intervention continued to report high levels of satisfaction with their treatment (95% CI 32.3-33.2 at 1 year), and Ͼ90% strongly agreed or agreed that the telecarer approach was acceptable. Qualitative comments pointed to the importance of a personalized service; increased feelings of well-being, including confidence and self-control; help with problem-solving; and patients developing rapport and a strong bond with the telecarers.CONCLUSIONS -A personalized PACCTS approach is acceptable to patients. A service giving priority to the interpersonal dimension leads to increased commitment from patients to improve long-term glycemic control. Diabetes Care 28:283-289, 2005

The aim of this qualitative study is to explore practice nurses' perceptions of their role in providing diabetes care. Semi-structured interviews were conducted with 15 purposively selected general practice nurses working in the Northwest of England. Five main themes were identified through coding and demonstrate that definitions of diabetes service are complex and that variations exist in perceptions of care. The main findings give an insight into practice nurses' perceptions of their scope and level of practice in primary diabetes care. This research highlights practice nurses' training needs in order to meet new national guidelines in diabetes care.

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This article gives an overview of antipsychotic medication and of tardive dyskinesia (TD). It examines the research available on TD as it relates to people with a learning disability (PWLD). The evidence identifies that specific groups of people are at an increased risk of developing TD. It also shows that 45-50% of PWLD who are treated with antipsychotic medication will be affected by TD. The evidence is used in the formulation of an assessment tool designed for use by the community learning disability nurse to identify an individual's risk of developing TD before commencing medication. Litigation in the USA has led to a $6.7 m award for sound, clinically effective practice and evidence-based interventions requires that practitioners are accountable for their practice, but are also seen to transform existing services in a way which improves the delivery of quality interventions and care.