Interprofessional Training to Improve Diabetes Care: The ReSPECT Trial

Diabetes Mellitus Clinical Trial

— ReSPECT  

Official title:

Interprofessional Training for Improving Diabetes Care

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT00854594
• Other study ID #: EDU 08-414
• Status: Completed
• Phase: N/A
• First received: February 27, 2009
• Last updated: September 2, 2015
• Start date: September 2010
• Est. completion date: September 2013

Study information

• Verified date: September 2015
• Source: VA Office of Research and Development
• Contact: n/a
• Is FDA regulated: No
• Health authority: United States: Federal Government
• Study type: Interventional

Clinical Trial Summary

The investigators' study focuses on improving the care of diabetes, a complex chronic illness, by providing important insights into interprofessional training and its potential role in fostering the necessary interdisciplinary management needed for chronic conditions and in addressing the gap between best practice and actual care provided.

Description:

The complexity of diabetes management challenges the acute care-oriented healthcare system. Some experts suggest part of the problem is that the healthcare system fosters a separate silos decision making model. While there is increasing recognition that quality diabetes care is best provided in an interdisciplinary manner, interprofessional training models are limited, as is understanding of the links between interprofessional training, actual practice, and patient outcomes. Advancing our understanding of interprofessional training models is critical because most of the complications associated with diabetes (e.g., amputations, renal failure, strokes) can be prevented or delayed with proper management. The investigators' objective is to better understand the processes and mechanisms by which interprofessional training impacts on chronic care management (practice patterns) and the ways it translates into improved patient outcomes.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 117
• Est. completion date: September 2013
• Est. primary completion date: May 2013
• Accepts healthy volunteers: No
• Gender: Both
• Age group: 25 Years to 85 Years

Eligibility

Inclusion Criteria:

CLINICIANS

• All clinicians in all of Ohio's CBOCs (except for the Georgetown CBOC) will be eligible for the study (all PCPs have patients with DM in their panel of patients).

PATIENTS

• All diabetic patients who are seen in Ohio's CBOCs (except for the Georgetown CBOC) will be eligible for the study.

Exclusion Criteria:

CLINICIANS

• Any clinician who does not have diabetic patients on their panel, who aren't apart of Ohio's CBOC's, or see patients at the Georgetown CBOC will not be eligible to participate.

PATIENTS

• Patients who don't have a diagnosis of diabetes, who aren't seen at one of Ohio's CBOC's, or is seen for their medical care at the Georgetown CBOC will not be eligible to participate.

Study Design

Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Prevention

Related Conditions & MeSH terms

• Diabetes Mellitus

Intervention

Behavioral:
• Role modeling in Shared medical appointments to Promote Establishing Collaborative Teams (ReSPECT)
The intervention is designed to educate the clinicians at intervention CBOCs by modeling interprofessional team practices during SMAs for diabetes mellitus (DM) patients from each CBOC primary care provider's (PCP) patient panel. We hypothesize that this education at intervention CBOCs will improve interprofessional practices and overall quality care delivered to veterans.

Locations

Country	Name	City	State
United States	Louis Stokes VA Medical Center	Cleveland	Ohio

Sponsors (3)

Lead Sponsor	Collaborator
VA Office of Research and Development	Case Western Reserve University, The Cleveland Clinic

Country where clinical trial is conducted

United States, 

References & Publications (1)

Kirsh SR, Schaub K, Aron DC. Shared medical appointments: a potential venue for education in interprofessional care. Qual Manag Health Care. 2009 Jul-Sep;18(3):217-24. doi: 10.1097/QMH.0b013e3181aea27d. — View Citation

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Provider Abilities Scale - Subscale From the Midwest (MW) Clinicians' Network	Providers asked to indicate their level of confidence on an 11-point scale, with 0 indicating 'not at all confident' and 10 indicating 'extremely confident' for the following activities: Instruct patients on home glucose monitoring; Teach foot care; Teach insulin administration; Instruct patients about diet; Help patients make changes in their diets that you have recommended; Instruct patients about regular exercise; Help patients make changes in their exercise habits that you have recommended; Identify candidates for long-acting insulin; Interpret glucose patterns; Adjust insulin in insulin-treated patients with poor glycemic control; Do you feel comfortable knowing whether to titrate basal insulin versus bolus insulin; Manage patients with poor glycemic control; Initiate insulin therapy (NPH or insulin glargine and aspart); Apply principles of diabetes care in a team setting; Averages of provider efficacy were calculated across all activities.	Baseline	No
Primary	Provider Abilities Scale - Subscale From the Midwest (MW) Clinicians' Network	Providers asked to indicate their level of confidence on an 11-point scale, with 0 indicating 'not at all confident' and 10 indicating 'extremely confident' for the following activities: Instruct patients on home glucose monitoring; Teach foot care; Teach insulin administration; Instruct patients about diet; Help patients make changes in their diets that you have recommended; Instruct patients about regular exercise; Help patients make changes in their exercise habits that you have recommended; Identify candidates for long-acting insulin; Interpret glucose patterns; Adjust insulin in insulin-treated patients with poor glycemic control; Do you feel comfortable knowing whether to titrate basal insulin versus bolus insulin; Manage patients with poor glycemic control; Initiate insulin therapy (NPH or insulin glargine and aspart); Apply principles of diabetes care in a team setting; Averages of provider efficacy were calculated across all activities.	22 months (post-intervention)	No
Secondary	Attitudes Toward Healthcare Teams Scale and Subscales	A validated scale developed to assess attitudes towards teams in a healthcare setting with three subscales to assess attitudes toward team value, attitudes toward team efficiency, and attitudes towards physician's shared role on a team. Each of the 21 items is rated 1 to 6, ranging from 'Strongly Disagree' to 'Strongly Agree'. The scale was considered 'complete' for analysis among providers who answered at least 7 of the 21 items. Items were reverse-coded as specified in the subscale development publication. Averages across completed items were calculated within provider. Higher values corresponded with more positive attitudes towards teams.	Baseline	No
Secondary	Attitudes Toward Healthcare Teams Scale and Subscales	A validated scale developed to assess attitudes towards teams in a healthcare setting with three subscales to assess attitudes toward team value, attitudes toward team efficiency, and attitudes towards physician's shared role on a team. Each of the 21 items is rated 1 to 6, ranging from 'Strongly Disagree' to 'Strongly Agree'. The scale was considered 'complete' for analysis among providers who answered at least 7 of the 21 items. Items were reverse-coded as specified in the subscale development publication. Averages across completed items were calculated within provider. Higher values corresponded with more positive attitudes towards teams.	22 months (post-intervention)	No