Figure 1. Trial design. RCT: randomized controlled trial; PRISMA: Proactive Interdisciplinary Self-Management; PEPPI: Perceived Efficacy in Patient-Physician Interactions; PN: practice nurse.
| Journal of Clinical Medicine Research, ISSN 1918-3003 print, 1918-3011 online, Open Access |
| Article copyright, the authors; Journal compilation copyright, J Clin Med Res and Elmer Press Inc |
| Journal website http://www.jocmr.org |
Original Article
Volume 12, Number 2, February 2020, pages 79-89
Effects of a Proactive Interdisciplinary Self-Management Program on Patient Self-Efficacy and Participation During Practice Nurse Consultations: A Randomized Controlled Trial in Type 2 Diabetes
Figures
Tables
| Task-oriented main topic with sub-categories | Communication behavior (examples) | ||
|---|---|---|---|
| Asking questions | Informing | Counselling | |
| RIAS: Roter interaction analysis system. | |||
| Medical Information about type 2 diabetes, tests to measure blood glucose levels, tests to measure other health values, other medical information | What is the difference between type 1 and type 2 diabetes? | I have had diabetes for 8 years now. | I am working on decreasing my blood glucose levels. |
| Therapeutic self-care, the prescription of medicines, usage of medicines, contact with health care providers, other therapeutic information | Is there another pill without side effects that I could try? | I take these pills twice a day, and other pills once a day. | This week I need to make an appointment for a pedicure. |
| Lifestyle nutrition, physical activity, alcohol use, smoking, social context, other lifestyle information | How many times a week do you advise to eat fish? | Sometimes we eat nuts in between meals. | Now it is time to diminish our carbohydrate intake. |
| Psychosocial mood, stress, coping with alcohol/smoking or diseases, problems with having a chronic disease, other psychosocial information | Do you think I should worry about my forgetfulness? | I feel really desolate all the time. | I said to myself: the stress is gone, so I quit smoking. |
| PEPPI | Videos | |||
|---|---|---|---|---|
| Intervention group (n = 60) | Control group (n = 59) | Intervention group (n = 60) | Control group (n = 55)a | |
| aThe PEPPI sample differed from the video sample by the number of cases. In the PEPPI sample, cases were missing due to non-response to the questionnaires. In the video sample, missing cases were due to withdrawal of general practices and failed or missing recordings. Because we focused on the patient and the PN, the spouses’ utterances are left out. bLow, no education or primary education; moderate, lower secondary education, (upper) secondary education or post-secondary non-tertiary education (including vocational education); and high, tertiary education (bachelor’s degree or higher). | ||||
| Patient characteristics | ||||
| Male (%) | 38 (63.3) | 40 (67.8) | 35 (58.3) | 34 (61.8) |
| Age in years (mean, SD) | 70.3 (10.0) | 71.0 (8.3) | 69.9 (10.0) | 70.6 (9.4) |
| Age in categories of | ||||
| < 50 | 1 (1.7) | 0 (0.0) | 1 (1.7) | 1 (1.8) |
| 50 - 59 | 6 (10.0) | 6 (10.9) | 9 (15.0) | 6 (10.9) |
| 60 - 69 | 18 (30.0) | 17 (30.9) | 16 (26.7) | 16 (29.1) |
| 70 - 79 | 25 (41.7) | 26 (47.3) | 26 (43.3) | 21 (38.2) |
| ≥ 80 | 10 (16.7) | 10 (18.2) | 8 (13.3) | 11 (20.0) |
| Education level (%)b | ||||
| Low | 2 (3.3) | 7 (11.9) | 2 (3.3) | 4 (7.3) |
| Moderate | 27 (45.0) | 32 (54.2) | 28 (46.7) | 28 (50.9) |
| High | 9 (15.0) | 7 (11.9) | 9 (15.0) | 6 (10.9) |
| Unknown | 22 (36.7) | 13 (22.0) | 21 (35.0) | 17 (30.9) |
| Visit the PN (%) | ||||
| Alone | N/A | N/A | 51 (85.0) | 46 (83.6) |
| Not alone | N/A | N/A | 9 (15.0) | 9 (16.4) |
| Use of blood glucose lowering medication (%) | ||||
| None | 9 (15.0) | 7 (11.9) | 10 (16.7) | 7 (12.7) |
| Tablets | 41 (68.3) | 39 (66.1) | 50 (83.3) | 41 (74.5) |
| Insulin | 1 (1.7) | 2 (3.4) | 0 (0.0) | 1 (1.8) |
| Unknown | 9 (15.0) | 11 (18.6) | 0 (0.0) | 6 (10.9) |
| Consultation characteristics | ||||
| Conversational contribution per patient (average number of utterances) | ||||
| Questions | 7.0 | 5.5 | ||
| Counselling | 0.2 | 0.3 | ||
| Providing information | 116.7 | 100.6 | ||
| Total | 123.9 | 106.4 | ||
| Topics discussed (average number of utterances per consultation per topic) | ||||
| Medical | 84.5 | 91.9 | ||
| Lifestyle | 88.8 | 64.8 | ||
| Therapeutic | 57.8 | 56.7 | ||
| Psychosocial | 10.6 | 5.6 | ||
| Duration of a consultation (in minutes mean, SD) | N/A | N/A | 21.5 (9.1) | 19.6 (8.3) |
| Patient contribution to the conversation | Number of utterances PN | Number of utterances patient | Topics discussed | Consultation duration (B, SE) | ||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Asking questions (B, SE) | Counselling (B, SE) | Providing information (B, SE) | Medical (B, SE) | Therapeutic (B, SE) | Medical (B, SE) | Therapeutic (B, SE) | Lifestyle (B, SE) | Psychosocial (B, SE) | ||||||||||||
| B: regression coefficient; SE: standard error; PRISMA: Proactive Interdisciplinary Self-Management. *P < 0.05. | ||||||||||||||||||||
| Main outcomes | ||||||||||||||||||||
| Available cases | 2.01 | 1.18 | -0.15* | 0.09 | -3.88 | 10.78 | 8.55 | 13.45 | 2.97 | 11.84 | -0.00 | 9.32 | 13.90 | 9.76 | 13.98 | 10.57 | 1.89 | 3.81 | 0.94 | 1.71 |
| Per protocol (attended PRISMA) | -2.20 | 1.20 | 0.22 | 0.09* | 13.19 | 10.96 | 11.54 | 13.71 | 11.32 | 12.05 | 20.40* | 9:51 | -25.90* | 9.88 | 12.94 | 10.78 | 3.41 | 3.85 | 0.97 | 1.75 |
| Associations with characteristics | ||||||||||||||||||||
| Female | -0.11 | 1.04 | 0.10 | 0.08 | 11.17 | 9.66 | 3.54 | 12.12 | 10.15 | 10.59 | 8.75 | 8.44 | 9.15 | 8.58 | 7.54 | 9.55 | -4.47 | 3.37 | 0.75 | 1.55 |
| Age | 0.09 | 0.05 | -0.01 | -0.00 | 0.96 | 0.50 | -0.38 | 0.62 | 1.01 | 0.55 | 0.07 | 0.43 | 0.37 | 0.45 | -0.18 | 0.49 | -0.08 | 0.18 | 0.05 | 0.08 |
| Diabetes duration | 0.08 | 0.12 | -0.01 | 0.01 | 3.16* | 1.17 | 1.25 | 1.45 | 3.18* | 1.26 | 1.70 | 1.01 | 2.70* | 1.02 | 1.89 | 1.14 | 0.26 | 0.41 | 0.33 | 0.19 |
| Presence spouse | -2.08 | 1.44 | 0.93 | 0.11 | -36.12* | 13.25 | 25.59 | 16.56 | -42.64* | 14.53 | 22.61* | 11.51 | 3.85 | 11.89 | 8.98 | 13.03 | -4.40 | 4.67 | 4.55* | 2.11 |