Poor uptake of an online intervention in a cluster randomised controlled trial of online diabetes education for rural general practitioners

Abstract

BackgroundIn Australia, rural and remote communities have high rates of diabetes-related death and hospitalisation. General practitioners (GPs) play a major role in diabetes detection and management. Education of GPs could optimise diabetes management and improve patient outcomes at a population level. The study aimed to describe the uptake of a continuing medical education intervention for rural GPs and its impact on the viability of a cluster randomised controlled trial of the effects of continuing medical education on whole-town diabetes monitoring and control.MethodTrial design: the cluster randomised controlled trial involved towns as the unit of allocation and analysis with outcomes assessed by de-identified pathology data (not reported here). The intervention programme consisted of an online active learning module, direct electronic access to specialist advice and performance feedback. Multiple rounds of invitation were used to engage GPs with the online intervention content. Evidence-based strategies (e.g. pre-notification, rewards, incentives) were incorporated into the invitations to enrol in the programme. Recruitment to the programme was electronically monitored through the hosting software package during the study intervention period.ResultsEleven matched pairs of towns were included in the study. There were 146 GPs in the 11 intervention towns, of whom 34 (23.3%) enrolled in the programme, and 8 (5.5%) completed the online learning module. No town had more than 10% of the resident GPs complete the learning module. There were no contacts made by GPs regarding requests for specialist advice. Consequently, the trial was discontinued.ConclusionThere is an ongoing need to engage primary care physicians in improving diabetes monitoring and management in rural areas. Online training options, while notionally attractive and accessible, are not likely to have high levels of uptake, even when evidence-based recruitment strategies are implemented.Trial registrationAustralian New Zealand Clinical Trials Registry, identifier: ACTRN12611000553976. Retrospectively registered on 31 May 2011.

Developing and testing a web‐based intervention to encourage early help‐seeking in people with symptoms associated with lung cancer

“…Of those who showed interest in our website (by engaging in some form of interaction after viewing the homepage), 21.2% completed the study. Low participation levels of between 10 and 12% have been noted in previous web‐based interventions (Paul et al ., ; Peels et al ., ), and some even report levels as low as 0.24% (Koo & Skinner, ), although others report more positive experiences (Murray et al ., ). Additionally, online trials have often been associated with low retention levels (Mathieu, McGeechan, Barratt, & Herbert, ; Murray et al ., ).…”

Recruiting general practice patients for large clinical trials: lessons from the Aspirin in Reducing Events in the Elderly ( ASPREE ) study

“…Some GPs report unease with participant randomisation and researchers must therefore justify equipoise, “a state of genuine uncertainty … regarding the comparative therapeutic merits of each arm in a trial” . The proportion of approached GPs who agreed to participate in the study (47%) was higher than for ANBP2 (17%) and other studies, indicating that there was significant interest in the research question examined by ASPREE, an interpretation confirmed by a large amount of anecdotal feedback from GPs.…”

“…However, more recent reports have highlighted barriers to recruiting participants through general practices, including time constraints for GPs and workforce shortages, lack of remuneration, not recognising GPs as investigators, and lack of interest in the research question . Further, there is little infrastructure support for GPs participating in data collection and research …”

Technology in Diabetes Treatment: Update and Future

“…Electronic teaching: Participation in structured treatment and teaching programs is strongly recommended for all patients with diabetes. The first studies about clinical use of electronic and online treatment programs failed to have high levels of uptake, but they also demonstrated a comparable effect to programs with conventional teaching and learning (67)(68)(69)(70). Electronic and online learning offers new possibilities.…”

“…This is an important limitation for reflective learning (63)(64)(65)(66). The first studies about clinical use of electronic and online treatment programs failed to have high levels of uptake, but they also demonstrated a comparable effect to programs with conventional teaching and learning (67)(68)(69)(70). These results may lead to the conclusion that up to the present, electronic programs are not superior, but they are rather suitable in patients who do not have easy access to participate in a face-toface teaching and treatment programs.…”