A RANDOMIZED CONTROLLED TRIAL OF AN INTERVENTION DESIGNED TO IMPROVE THE CARE GIVEN IN GENERAL-PRACTICE TO TYPE-II DIABETIC-PATIENTS - PATIENT OUTCOMES AND PROFESSIONAL ABILITY TO CHANGE BEHAVIOR

Aim. Our objective was to evaluate the effect of training in a patient -centred intervention for GPs and practice nurses on outcomes for pati ents with Type II diabetes. Methods. We carried out a randomized contr olled trial within general practices as the basis for randomization an d a before-and-after design for measures of patient outcome. A paralle l process study examined the use of the method by professionals. The s tudy was carried out in 29 general practices in South Glamorgan who ha d participated for at least 2 years in a local scheme of audit and CME in relation to Type II diabetes care. The subjects were 252 Type II d iabetic patients recruited by 15 experimental and 14 control practices . The main outcome measures were changes in glycosylated haemoglobin, patient satisfaction with care and treatment, functional health status and professional ability to apply the intervention. Results. Professi onals adopted the innovative method with enthusiasm, but after 2 years only 19% continued to apply the method systematically. The trial was, therefore, unable to demonstrate significant biochemical or functiona l improvements. This highlights the need to understand the factors ass ociated with professional uptake and subsequent ability to sustain cha nges in behaviour. Conclusions. The efficacy of this behavioural inter vention remains unproved, despite its acceptability to professional st aff. Detailed and prolonged development and testing of behavioural int erventions is an essential first step before embarking on randomized c ontrolled trials which involve complex behavioural changes in professi onals or patients.