title: The Aging, Community and Health Research Unit-Community Partnership Program for older adults with type 2 diabetes and multiple chronic conditions: a feasibility study.
abstract: BACKGROUND
  Few studies have examined the effectiveness of community-based self-management interventions in older adults with type 2 diabetes mellitus (T2DM) and multiple chronic conditions (MCC). The objectives of this study were to examine the feasibility of implementation in practice (primary) and the feasibility of study methods and potential effectiveness (secondary) of the Aging, Community and Health-Community Partnership Program, a new 6-month interprofessional, nurse-led program to promote diabetes self-management in older adults (>65 years) with T2DM and MCC.
  
  
  METHODS
  This study used a prospective one-group pre-test/post-test design. Participants were recruited from a specialized diabetes clinic. They received a median of three in-home/clinic visits by certified diabetes educators (CDEs) and attended a median of three group wellness sessions provided by the CDEs in partnership with a community-based seniors' association. The primary outcome was the feasibility of the program (acceptability, fidelity, implementation barriers/facilitators). Secondary outcomes included the feasibility of the study methods (recruitment/retention rates and procedures, eligibility criteria, data collection and analysis methods) and potential effectiveness of the program based on 6-month changes in self-reported outcomes including self-management behavior (diet, exercise, self-monitoring), health status (quality of life, mental health), and costs of service use. Analysis of feasibility outcomes was primarily based on descriptive statistics. The potential effectiveness of the program was explored using different tests, with the results expressed using descriptive statistics and effect estimates (95 % confidence intervals).
  
  
  RESULTS
  In total, 45 (88 %) of 51 eligible persons consented to participate. Of these, 37 (82 %) completed the 6-month follow-up. Participants and providers viewed the program as acceptable and feasible. Participants had a higher SF-12 physical component summary score at 6 months compared with baseline (mean score difference 3.0, 95 % CI 0.2-5.8). Median costs for diabetes care increased over 6 months (reflecting inclusion of program costs), while other service costs either decreased or remained unchanged.
  
  
  CONCLUSIONS
  This study offers preliminary evidence that the program was feasible to deliver and acceptable to participants and providers. Initial results suggest that the program may improve physical functioning. A randomized controlled trial is feasible, with some adaptations to the program and study methods that were identified from this feasibility study.
  
  
  BACKGROUND
  Clinicaltrials.gov identifier: NCT01880476.
authors.affiliation: School of Nursing, Health Sciences Centre, McMaster University, 1280 Main Street West, Room 3N25B, Hamilton, ON L8S 4 K1 Canada.
authors.forename: Maureen
authors.initials: M
authors.lastname: Markle-Reid
authors.affiliation: School of Nursing, Health Sciences Centre, McMaster University, 1280 Main Street West, Room 3N25C, Hamilton, ON L8S 4 K1 Canada.
authors.forename: Jenny
authors.initials: J
authors.lastname: Ploeg
authors.affiliation: School of Nursing, Health Sciences Centre, McMaster University, 1280 Main Street West, Room 2J34A, Hamilton, ON L8S 4 K1 Canada.
authors.forename: Kathryn
authors.initials: K
authors.lastname: Fisher
authors.affiliation: School of Nursing, Health Sciences Centre, McMaster University, 1280 Main Street West, Room 3N25B, Hamilton, ON L8S 4 K1 Canada.
authors.forename: Holly
authors.initials: H
authors.lastname: Reimer
authors.affiliation: School of Nursing, Health Sciences Centre, McMaster University, 1280 Main Street West, Room 3N25B, Hamilton, ON L8S 4 K1 Canada.
authors.forename: Sharon
authors.initials: S
authors.lastname: Kaasalainen
authors.affiliation: Department of Clinical Epidemiology and Biostatistics, Centre for Health Economics and Policy Analysis, McMaster University, 1280 Main Street West, Room CRL-208, Hamilton, ON L8S 4 K1 Canada.
authors.forename: Amiram
authors.initials: A
authors.lastname: Gafni
authors.affiliation: University Department of Family Medicine, University of Alberta, 6-40 University Terrace, Edmonton, AB T6G 2T4 Canada.
authors.forename: Andrea
authors.initials: A
authors.lastname: Gruneir
authors.affiliation: Guelph Family Health Team, Dawson Road Family Medical Centre, 83 Dawson Rd, Guelph, ON N1H 1B1 Canada.
authors.forename: Ross
authors.initials: R
authors.lastname: Kirkconnell
authors.affiliation: Diabetes Care Guelph, Dawson Road Family Medical Centre, 83 Dawson Rd, Guelph, ON N1H 1B1 Canada.
authors.forename: Sam
authors.initials: S
authors.lastname: Marzouk
authors.affiliation: School of Nursing, Health Sciences Centre, McMaster University, 1280 Main Street West, Room 3N28B, Hamilton, ON L8S 4 K1 Canada.
authors.forename: Noori
authors.initials: N
authors.lastname: Akhtar-Danesh
authors.affiliation: Department of Clinical Epidemiology and Biostatistics, St. Joseph's Healthcare Hamilton, 3rd Floor, Martha Wing, Room H-325, 50 Charlton Avenue East, Hamilton, ON L8N 4A6 Canada.
authors.forename: Lehana
authors.initials: L
authors.lastname: Thabane
authors.affiliation: School of Pharmacy, University of Waterloo, 200 University Avenue West, Waterloo, ON N2L 3G1 Canada.
authors.forename: Carlos
authors.initials: C
authors.lastname: Rojas-Fernandez
authors.affiliation: Division of Clinical Public Health, Dalla Lana School of Public Health, 155 College Street, 6th floor, Toronto, ON M5T 3M7 Canada.
authors.forename: Ross
authors.initials: R
authors.lastname: Upshur
keywords: Community-based care; Diabetes self-management; Feasibility study; Interdisciplinary; Nurse-led intervention; Older adults