title: Provision of structured diabetes information encourages activation amongst people with diabetes as measured by diabetes care process attainment: the WICKED Project.
abstract: BACKGROUND
  People with diabetes have better outcomes if they actively participate in their care. Patient-focused interventions can be effective in activating patients. Yet there is no known trial to evaluate the impact of the provision of individualized diabetes-specific information on patient activation and diabetes care outcomes.
  
  
  METHODS
  In a randomized controlled trial, all people (n = 14 559) with diabetes within the local health economy were recruited and cluster randomized into two groups with the active group mailed a structured personalized report containing information on all nine of their diabetes care processes, whereas the control group received standard care. Differences in their Failed Process Score (FPS) were compared at three months.
  
  
  RESULTS
  At three months, the FPS score (1.25 ± 1.87 vs. 1.35 ± 1.97, P < 0.01) and the change in FPS score (0.48 ± 1.55 vs. 0.42 ± 1.49, P < 0.02) were significantly better in those mailed a structured personalized report. A dichotomized FPS score [good attainment (GA) vs. poorer attainment], was significantly better in those mailed (χ2 = 10.0, P < 0.05) and using a binary logistic regression analysis adjusting for all demographic factors and the baseline FPS, the relative effect of mailing compared with non-mailing on three-month GA category was OR 1.14 (95% CI 1.04-1.25, P < 0.01).
  
  
  CONCLUSIONS
  Provision of structured and individualized information to people with diabetes can positively influence the level of patient activation, promote better engagement and open the potential to improve other crucial diabetes outcomes.
authors.affiliation: Wolverhampton Diabetes Centre, New Cross Hospital, Wolverhampton, UK.
authors.forename: S M R
authors.initials: SM
authors.lastname: Gillani
authors.affiliation: University of Wolverhampton, UK.
authors.forename: A
authors.initials: A
authors.lastname: Nevill
authors.affiliation: Wolverhampton Diabetes Centre, New Cross Hospital, Wolverhampton, UK.
authors.forename: B M
authors.initials: BM
authors.lastname: Singh
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016000:Cluster Analysis; D015331:Cohort Studies; D003131:Combined Modality Therapy; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000628:therapy; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000628:therapy*; D004739:England; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D017145:Models, Educational; D010349:Patient Compliance; D010353:Patient Education as Topic; D018802:Patient-Centered Care; D011177:Postal Service; D057285:Precision Medicine; D011320:Primary Health Care; D055815:Young Adult
chemical_list: D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human