Effectiveness of general practice based, practice nurse led telephone coaching on glycaemic control of type 2 diabetes: the Patient Engagement And Coaching for Health (PEACH) pragmatic cluster randomised controlled trial

Abstract

Objective To evaluate the effectiveness of goal focused telephone coaching by practice nurses in improving glycaemic control in patients with type 2 diabetes in Australia.Design Prospective, cluster randomised controlled trial, with general practices as the unit of randomisation.Setting General practices in Victoria, Australia.Participants 59 of 69 general practices that agreed to participate recruited sufficient patients and were randomised. Of 829 patients with type 2 diabetes (glycated haemoglobin (HbA1c) >7.5% in the past 12 months) who were assessed for eligibility, 473 (236 from 30 intervention practices and 237 from 29 control practices) agreed to participate.Intervention Practice nurses from intervention practices received two days of training in a telephone coaching programme, which aimed to deliver eight telephone and one face to face coaching episodes per patient.Main outcome measures The primary end point was mean absolute change in HbA1c between baseline and 18 months in the intervention group compared with the control group.Results The intervention and control patients were similar at baseline. None of the practices dropped out over the study period; however, patient attrition rates were 5% in each group (11/236 and 11/237 in the intervention and control group, respectively). The median number of coaching sessions received by the 236 intervention patients was 3 (interquartile range 1-5), of which 25% (58/236) did not receive any coaching sessions. At 18 months’ follow-up the effect on glycaemic control did not differ significantly (mean difference 0.02, 95% confidence interval −0.20 to 0.24, P=0.84) between the intervention and control groups, adjusted for HbA1c measured at baseline and the clustering. Other biochemical and clinical outcomes were similar in both groups.Conclusions A practice nurse led telephone coaching intervention implemented in the real world primary care setting produced comparable outcomes to usual primary care in Australia. The addition of a goal focused coaching role onto the ongoing generalist role of a practice nurse without prescribing rights was found to be ineffective.Trial registration Current Controlled Trials ISRCTN50662837.

Comment on O’Connor et al. Randomized Trial of Telephone Outreach to Improve Medication Adherence and Metabolic Control in Adults With Diabetes. Diabetes Care 2014;37:3317–3324

“…In our study of outreach telephone coaching by practice nurses in Australian primary care settings (the Patient Engagement and Coaching for Health [PEACH] study), we found that a more intensive outreach intervention (median of three telephone contacts by the practice nurse per intervention patient, median of 30 min per call, reaching 75% of participants) also did not produce favorable outcomes (2). In our sample, 94% were on hypoglycemic agents, 72% on antihypertensive agents, and 64% on hypolipidemic agents at baseline (2,3).…”

Effectiveness of Interactive Self‐Management Interventions in Individuals With Poorly Controlled Type 2 Diabetes: A Meta‐Analysis of Randomized Controlled Trials

“…Ten of the trials made reference to strategies to enhance the intervention fidelity: Intensive trainings (Blackberry et al., ; Kim et al., ; Krein et al., ; Naik et al., ; Philis‐Tsimikas et al., ; Schwedes, Siebolds, & Mertes, ; Tang et al., ; Welch, Zagarins, Feinberg, & Garb, ; Williams et al., ) and ongoing monitoring (Blackberry et al., ; Farmer et al., ; Philis‐Tsimikas et al., ; Schwedes et al., ; Welch et al., ).…”

Nurse-Led Behavioral Management of Diabetes and Hypertension in Community Practices: A Randomized Trial

“…Moreover, we are not alone in experiencing this difficulty in community practices; since the end of our trial, three trials have been published of similar interventions in community practices in three countries in Europe, all of which showed no impact on clinical outcomes. [25][26][27] The purpose of our trial was to rigorously evaluate an intervention similar to nurse behavioral management interventions that have almost certainly been implemented in a number of community practices. These interventions likely show apparent efficacy in uncontrolled settings, thus encouraging practices to continue to devote resources to nurse management.…”