Patient Engagement and Coaching for Health: The PEACH study--a cluster randomised controlled trial using the telephone to coach people with type 2 diabetes to engage with their GPs to improve diabetes care: a study protocol.
BACKGROUND
The PEACH study is based on an innovative 'telephone coaching' program that has been used effectively in a post cardiac event trial. This intervention will be tested in a General Practice setting in a pragmatic trial using existing Practice Nurses (PN) as coaches for people with type 2 diabetes (T2D). Actual clinical care often fails to achieve standards, that are based on evidence that self-management interventions (educational and psychological) and intensive pharmacotherapy improve diabetes control. Telephone coaching in our study focuses on both. This paper describes our study protocol, which aims to test whether goal focused telephone coaching in T2D can improve diabetes control and reduce the treatment gap between guideline based standards and actual clinical practice.


METHODS
In a cluster randomised controlled trial, general practices employing Practice Nurses (PNs) are randomly allocated to an intervention or control group. We aim to recruit 546 patients with poorly controlled T2D (HbA1c >7.5%) from 42 General Practices that employ PNs in Melbourne, Australia. PNs from General Practices allocated to the intervention group will be trained in diabetes telephone coaching focusing on biochemical targets addressing both patient self-management and engaging patients to work with their General Practitioners (GPs) to intensify pharmacological treatment according to the study clinical protocol. Patients of intervention group practices will receive 8 telephone coaching sessions and one face-to-face coaching session from existing PNs over 18 months plus usual care and outcomes will be compared to the control group, who will only receive only usual care from their GPs. The primary outcome is HbA1c levels and secondary outcomes include cardiovascular disease risk factors, behavioral risk factors and process of care measures.


CONCLUSIONS
Understanding how to achieve comprehensive treatment of T2D in a General Practice setting is the focus of the PEACH study. This study explores the potential role for PNs to help reduce the treatment and outcomes gap in people with T2D by using telephone coaching. The intervention, if found to be effective, has potential to be sustained and embedded within real world General Practice.
Young
Doris
D
Department of General Practice, The University of Melbourne, Melbourne, Australia. d.young@unimelb.edu.au <d.young@unimelb.edu.au>
Furler
John
J
Vale
Margarite
M
Walker
Christine
C
Segal
Leonie
L
Dunning
Patricia
P
Best
James
J
Blackberry
Irene
I
Audehm
Ralph
R
Sulaiman
Nabil
N
Dunbar
James
J
Chondros
Patty
P
D001315:Australia; D001786:Blood Glucose / Q000032:analysis; D015190:Blood Glucose Self-Monitoring; D016000:Cluster Analysis; D048909:Diabetes Complications / Q000517:prevention & control; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000188:drug therapy* / Q000451:nursing; D005194:Family Practice / Q000379:methods*; D005260:Female; D006442:Glycated Hemoglobin / Q000031:analogs & derivatives*; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D008297:Male; D009722:Nurse Practitioners / Q000706:statistics & numerical data; D009723:Nurse-Patient Relations; D010353:Patient Education as Topic / Q000379:methods*; D010358:Patient Participation; D012016:Reference Values; D018570:Risk Assessment; D016037:Single-Blind Method; D013689:Telephone
D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; C025617:glucosylated hemoglobin A