Abstract:Background:Assessing the fidelity of an implementation strategy is important to understand why and how the strategy influences the uptake of evidence-based interventions. The present study aims to assess the fidelity of the two procedures for engaging primary care (PC) professionals and for the deployment of an implementation strategy for optimizing type 2 diabetes prevention in routine PC within the PREDIAPS randomized cluster implementation trial. Method:We conducted an observational descriptive fidelity eva… Show more
“…The PVS-PREDIAPS implementation strategy is based on a collaborative modeling process with an external facilitator, allowing the evidence-based clinical intervention for the primary prevention of T2D through the promotion of healthy lifestyles to be adapted to the context and determinants of local clinical practice of the centers, maximizing the feasibility of performing the intervention and its efficacy in real-world clinical practice conditions [ 10 , 28 ]. The strategy, based on the creation of interprofessional community of practice led and driven by a previously selected local leader and an external facilitator, has an implementation phase with three key components and a post-implementation phase.…”
Section: Methodsmentioning
confidence: 99%
“…1 ). A detailed description of the PVS-PREDIAPS implementation strategy and its actions has been published elsewhere [ 10 , 28 ]. Fig.…”
Section: Methodsmentioning
confidence: 99%
“…Despite some differential exposure to the overall strategy within the nursing staff in the groups compared, the professionals involved have received notably high exposure to the implementation strategy, and the planned program differentiation (related to engagement of professionals and deployment of the implementation strategy) has been attained. The implementation strategy and fidelity of execution have been described in detail elsewhere [ 10 , 28 ].…”
Background
The most efficient procedures to engage and guide healthcare professionals in collaborative processes that seek to optimize practice are unknown. The PREDIAPS project aims to assess the effectiveness and feasibility of different procedures to perform a facilitated interprofessional collaborative process to optimize type 2 diabetes prevention in routine primary care.
Methods
A type II hybrid cluster randomized implementation trial was conducted in nine primary care centers of the Basque Health Service. All centers received training on effective healthy lifestyle promotion. Headed by a local leader and an external facilitator, centers conducted a collaborative structured process—the PVS-PREDIAPS implementation strategy—to adapt the intervention and its implementation to their specific context. The centers were randomly allocated to one of two groups: one group applied the implementation strategy globally, promoting the cooperation of all health professionals from the beginning, and the other performed it sequentially, centered first on nurses, who later sought the pragmatic cooperation of physicians. The following patients were eligible for inclusion: all those aged ≥ 30 years old with at least one known cardiovascular risk factor and an impaired fasting glucose level (≥ 110-125 mg/dl) but without diabetes who attended centers during the study period. The main outcome measures concerned changes in type 2 diabetes prevention practice indicators after 12 months.
Results
After 12 months, 3273 eligible patients at risk of type 2 diabetes had attended their family physician at least once, and of these, 490 (15%) have been addressed by assessing their healthy lifestyles in both comparison groups. The proportion of at-risk patients receiving a personalized prescription of lifestyle change was slightly higher (8.6%; range 13.5-5.9% vs 6.8%; range 7.2-5.8%) and 2.3 times more likely (95% CI for adjusted hazard ratio, 1.38-3.94) in the sequential than in the global centers, after 8 months of the intervention program implementation period. The probability of meeting the recommended levels of physical activity and fruit and vegetable intake were four- and threefold higher after the prescription of lifestyle change than only assessment and provision of advice. The procedure of engagement in and execution of the implementation strategy does not modify the effect of prescribing healthy habits (p interaction component of intervention by group, p > 0.05).
Discussion
Our results show that the PVS-PREDIAPS implementation strategy manages to integrate interventions with proven efficacy in the prevention of type 2 diabetes in clinical practice in primary care. Further, they suggest that implementation outcomes were somewhat better with a sequential facilitated collaborative process focused on enhancing the autonomy and responsibility of nurses who subsequently seek a pragmatic cooperation of GPs.
Trial registration
Clinicaltrials.gov identifier: NCT03254979. Registered 16 August 2017—retrospectively registered.
“…The PVS-PREDIAPS implementation strategy is based on a collaborative modeling process with an external facilitator, allowing the evidence-based clinical intervention for the primary prevention of T2D through the promotion of healthy lifestyles to be adapted to the context and determinants of local clinical practice of the centers, maximizing the feasibility of performing the intervention and its efficacy in real-world clinical practice conditions [ 10 , 28 ]. The strategy, based on the creation of interprofessional community of practice led and driven by a previously selected local leader and an external facilitator, has an implementation phase with three key components and a post-implementation phase.…”
Section: Methodsmentioning
confidence: 99%
“…1 ). A detailed description of the PVS-PREDIAPS implementation strategy and its actions has been published elsewhere [ 10 , 28 ]. Fig.…”
Section: Methodsmentioning
confidence: 99%
“…Despite some differential exposure to the overall strategy within the nursing staff in the groups compared, the professionals involved have received notably high exposure to the implementation strategy, and the planned program differentiation (related to engagement of professionals and deployment of the implementation strategy) has been attained. The implementation strategy and fidelity of execution have been described in detail elsewhere [ 10 , 28 ].…”
Background
The most efficient procedures to engage and guide healthcare professionals in collaborative processes that seek to optimize practice are unknown. The PREDIAPS project aims to assess the effectiveness and feasibility of different procedures to perform a facilitated interprofessional collaborative process to optimize type 2 diabetes prevention in routine primary care.
Methods
A type II hybrid cluster randomized implementation trial was conducted in nine primary care centers of the Basque Health Service. All centers received training on effective healthy lifestyle promotion. Headed by a local leader and an external facilitator, centers conducted a collaborative structured process—the PVS-PREDIAPS implementation strategy—to adapt the intervention and its implementation to their specific context. The centers were randomly allocated to one of two groups: one group applied the implementation strategy globally, promoting the cooperation of all health professionals from the beginning, and the other performed it sequentially, centered first on nurses, who later sought the pragmatic cooperation of physicians. The following patients were eligible for inclusion: all those aged ≥ 30 years old with at least one known cardiovascular risk factor and an impaired fasting glucose level (≥ 110-125 mg/dl) but without diabetes who attended centers during the study period. The main outcome measures concerned changes in type 2 diabetes prevention practice indicators after 12 months.
Results
After 12 months, 3273 eligible patients at risk of type 2 diabetes had attended their family physician at least once, and of these, 490 (15%) have been addressed by assessing their healthy lifestyles in both comparison groups. The proportion of at-risk patients receiving a personalized prescription of lifestyle change was slightly higher (8.6%; range 13.5-5.9% vs 6.8%; range 7.2-5.8%) and 2.3 times more likely (95% CI for adjusted hazard ratio, 1.38-3.94) in the sequential than in the global centers, after 8 months of the intervention program implementation period. The probability of meeting the recommended levels of physical activity and fruit and vegetable intake were four- and threefold higher after the prescription of lifestyle change than only assessment and provision of advice. The procedure of engagement in and execution of the implementation strategy does not modify the effect of prescribing healthy habits (p interaction component of intervention by group, p > 0.05).
Discussion
Our results show that the PVS-PREDIAPS implementation strategy manages to integrate interventions with proven efficacy in the prevention of type 2 diabetes in clinical practice in primary care. Further, they suggest that implementation outcomes were somewhat better with a sequential facilitated collaborative process focused on enhancing the autonomy and responsibility of nurses who subsequently seek a pragmatic cooperation of GPs.
Trial registration
Clinicaltrials.gov identifier: NCT03254979. Registered 16 August 2017—retrospectively registered.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
