The Patient Activation through Community Empowerment/Engagement for Diabetes Management (PACE-D) protocol: a non-randomised controlled trial of personalised care and support planning for persons living with diabetes

Abstract

Background: Personalised care and support planning (CSP) has been shown to improve diabetes outcomes, patient experience and provider morale in the care of persons living with diabetes. However, this has not been confirmed in controlled studies. Patient Activation through Community Empowerment/Engagement for Diabetes Management (PACE-D) is a pragmatic controlled trial that evaluates the effectiveness of personalised CSP in persons living with diabetes in the public primary care setting in Singapore. Methods: Teamlet-empanelled patients with diabetes at four polyclinics are recruited for this study. Participants who attend either of the two Intervention clinics are sent their investigation results in a care planning letter (CPL) to prepare them for the CSP conversation. This conversation is facilitated by a trained CSP practitioner who engages them in discussion of concerns, goals and action plans, and documents their plans for subsequent review. Participants in the two Control clinics will receive standard diabetes care. Participants will complete two or more CSP conversations (Intervention) or regular consultations (Control) at the annual review visits within the 18 months of the study. The sample size is calculated at 1620 participants, with glycated haemoglobin (HbA1c) as the primary outcome measure. Secondary outcome measures include patient activation (as measured by PAM-13) and changes in healthcare utilisation and cost. Discussion: This study is a pragmatic trial that evaluates the effectiveness of personalised CSP in persons living with diabetes in a real world setting. It promises to provide insights with regard to the implementation of this model of care in Singapore and the region.

What is meant by ‘integrated personalized diabetes management’: A view into the future and what success should look like

“…For instance, an in‐person annual check‐up visit combined with online follow‐up coaching at home. Blended services can improve the quality of integrated person‐centred care by providing better access and more flexible options to provide care according to individual needs 126–130 …”

“…Blended services can improve the quality of integrated person-centred care by providing better access and more flexible options to provide care according to individual needs. [126][127][128][129][130]…”

Effectiveness of a nurse‐led personalized patient engagement program to promote type 2 diabetes self‐management: A randomized controlled trial

“…Active engagement in DSM involves dynamic interaction among various experiential aspects, not only including developing knowledge, supporting behavior change, and improving decision‐making capacity but also accepting the diagnosis, complying with physiological and psychosocial changes, and elaborating individuals' role in their healthcare (Graffigna et al, 2016). Based on these assumptions, embracing patient engagement may be valuable in supporting diabetes patients (W. H. Tan, Loh, et al, 2020).…”

Implementing and evaluating care and support planning: a qualitative study of health professionals’ experiences in public polyclinics in Singapore

“…The trial, Patient Activation through Community Empowerment/Engagement for Diabetes management (PACE-D), is set in four polyclinics. Two polyclinics each developed their systems and introduced CSP into the working arrangements of one or two professional teamlets (small groups of doctors and nurses that provide care for a panel of patients) [ 16 , 17 ]. The PACE-D trial aims to recruit all adults with diabetes who can communicate in English, Chinese or Malay.…”

“…The PACE-D trial aims to recruit all adults with diabetes who can communicate in English, Chinese or Malay. The primary outcome is HbA1c levels (which the research team acknowledges fails to capture many potential benefits of CSP) [ 16 ].…”