Diabetes Mellitus, Type 2 Clinical Trial
— PACE-ItOfficial title:
PACE-It Study : Primary Care Based Integrated Community Care Team Intervention to Improve the Health Outcomes of Patients Living With Diabetes and Complex Needs - a Feasibility Study
Verified date | April 2022 |
Source | SingHealth Polyclinics |
Contact | n/a |
Is FDA regulated | No |
Health authority | |
Study type | Interventional |
PACE-It study is a non-blinded, mix-method randomized controlled trial within a single site. This study aims to test the feasibility of implementing a complex intervention comprising of a) a Primary Care Based integrated community care team delivery of person centered care, b) supported by a care co-ordination platform using a mobile application and its effectiveness in improving the glycemic control of patients living with Diabetes and have complex needs.
Status | Terminated |
Enrollment | 41 |
Est. completion date | February 8, 2022 |
Est. primary completion date | February 8, 2022 |
Accepts healthy volunteers | No |
Gender | All |
Age group | 50 Years and older |
Eligibility | Inclusion Criteria: - Living within the designated geographical zone - 50 years and above - Satisfy the Medical Criteria below: 1. Diabetes with HbA1c = 9% (within past 6 months), and 2. At least 1 complication 1. chronic kidney impairment stage 3 and above, or diabetes overt nephropathy, 2. ischaemic heart disease, or congestive cardiac failure, 3. peripheral arterial disease, or diabetes foot/ diabetes foot-related complications, 4. diabetic retinopathy/ treatment for retinopathy, and 5. stroke, or transient ischaemic attack - Satisfy at least 2 conditions in the psycho-social, functional or activation domain of which 1 criteria must be from the psycho-social domain: 1. Psycho-social issues a. Lack of care giver support i. No care-giver (when indicated) ii. Care-giver skills gap/ stress iii. Inability of copy when patient is the care-giver b. Difficult relationships (family/ workplace/ social network) c. Social isolation/ lack of social connectivity i. Lives alone ii. Lack of social network support d. Financial i. Financial difficulty/ insecurity ii. Housing/ shelter issues iii. Poor money management 2. Functional 1. Clinical Frailty Score = 4, requiring help in instrumental activities of daily living (iADL) 2. Requires assistance in ADL or iADL 3. Activation a. Lack of ability to manage health - disengaged or overwhelmed i. Anxiety or disease-related distress ii. Confusion or lack of understanding of care plans iii. Non-adherence to medications/ follow up - Patient gives consent to participate - For patients who may be seeing a Primary Care Physician (PCP) outside of the polyclinic for chronic disease management and where the PCP has indicated consent to co-manage the patient with the PACE-It team including the polyclinic physician - Patient must be willing to receive care in the polyclinic Exclusion Criteria: - Patients who are on follow up with Primary Care Physicians or General Practitioners elsewhere for management of their chronic conditions and they do not consent to co-managing patient with the PACE-It team - Patients who have severe cognitive impairment, depression or psychiatric conditions that interfere with the ability to engage with the healthcare team - Patients who are (i) not community ambulant or (ii) bed bound - Patients with terminal illness - Patients who have are in other programs or research studies - Patients who do not give consent |
Country | Name | City | State |
---|---|---|---|
Singapore | SingHealth Polyclinics - Marine Parade, 80 Marine Parade Central, #01-792 | Singapore |
Lead Sponsor | Collaborator |
---|---|
SingHealth Polyclinics | Agency for Integrated Care, Singapore, Ministry of Health, Singapore, SingHealth Regional Health System |
Singapore,
Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Primary | HbA1c | Glycemic control | 1 year | |
Secondary | Blood pressure | Systolic and diastolic blood pressure (mmHg) | 1 year | |
Secondary | LDL-cholesterol | Low-density lipoprotein cholesterol | 1 year | |
Secondary | Patient activation measure (PAM) | Patient's activation levels | 1 year | |
Secondary | Medication adherence measure (MARS-5) | Patient's adherence to medication | 1 year | |
Secondary | EQ-5D-5L | Quality of life | 1 year | |
Secondary | Patient satisfaction | Qualitative survey and interview | 1 year | |
Secondary | Provider's satisfaction | Qualitative survey and interview | 2 years | |
Secondary | Cost-effectiveness | Cost-effectiveness of care model | 2 years | |
Secondary | Implementation of care model | Factors affecting implementation of care model | 2 years |
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