A practice nurse addressed intervention to enhance self-management in people with type 2 diabetes

1. A practice nurse addressed intervention to enhance self-management in people with type 2 diabetes By Lise Juul, RN, MPH, Ph.D student Supervisors: Annelli Sandbaek, Helle Terkildsen Maindal, Vibeke Zoffmann Department of General Practice

2. An upcoming intervention study • Main activity: • A training course for practice nurses with autonomy support as the core component carried out in an implementation strategy • Why train practice nurses? • Why autonomy support? • A patientcentered approach • Crucial for motivation • Why in an implementation strategy? Department of General Practice

3. Aim • To implement and evaluate the effect of a nurse-led proactive support to enhance self-management in people with type 2 diabetes in general practice 1) implementation of autonomy supportive communication in nurse-consultations with patients with type 2 diabetes 2) effect-evaluation of the intervention on difference in patientoutcomes 3) association between effect of the intervention and education- level, gender and age? 4) association between attendance to proactive nurse- consultations uptil 3 months after invitation and education- level, gender and age? Department of General Practice

4. Program Theory Inspired by Rossi, et al. Evaluation. A Systematic Approach. 2004 Department of General Practice

5. Inputs • General practices with nurses with experience in having consultations with patients with type 2 diabetes • Competent teachers • Tools to guide the autonomy supportive process • Patients with type 2 diabetes, identified in ”Aarhus Diabetes Database”, and validated by the GPs Department of General Practice

6. Activities • A training course for practice nurses with autonomy support as the core component carried out in an implementation strategy Department of General Practice

7. Content of the training course • evidencebased treatment of type 2 diabetes • barriers and facilitators of health behaviour change • communication techniques • introduction of tools to guide the autonomy supportive process Department of General Practice

8. Implementation strategy • interactive educational meetings (4x4 hours over 6 months) • reminder and support by a linkage agent (3 telephone calls over 12 months) Department of General Practice

9. Activities • A training course for practice nurses with autonomy support as the core component carried out in an implementation strategy • Patients will be invited to consultations with the nurse Department of General Practice

10. Outputs • Nurses attend the course • Patients attend the consultations • Accept and use of the tools recommended in the course Department of General Practice

11. Initial outcomes • Patients • reflect about living with diabetes • in the framework of recommended diabetes care, identify goals that are meningful for them • take action to meet them Department of General Practice

12. Intermediate outcomes • Improved health behaviour, e.g. • more compliant to pharmalogical treatment • more physically active • more appropriate diet • smoking cessation • improved control (blood- and visiontests) Department of General Practice

13. Longer-Term outcomes • Improved HbA1c-values • Improved Total-cholesterol-values Less • Improved blood pressure Complications • Weight loss • Less perceived problems in relation to diabetes • Improved quality of life Department of General Practice

14. Design & studypopulation • Cluster randomized controlled trial • 30 general practices from the former county of Aarhus - nurses • About 1200 patients with type 2 diabetes - age 40-70 Department of General Practice

15. Follow-up • All patients will be followed 15 months • The invitations will be send over a 3 month-period within each practice Department of General Practice

16. Main points • An upcoming intervention study: • A training course for practice nurses with autonomy support as the core component carried out in an implementation strategy • Improved chance of behaviour change and maintenance if the behaviour is felt self chosen and meaningful. Department of General Practice

17. Thank you Department of General Practice