Poor uptake of an online intervention in a cluster randomised controlled trial of online diabetes education for rural general practitioners.
In Australia, rural and remote communities have high rates of diabetes-related death and hospitalisation. General practitioners (GPs) play a major role in diabetes detection and management. Education of GPs could optimise diabetes management and improve patient outcomes at a population level. The study aimed to describe the uptake of a continuing medical education intervention for rural GPs and its impact on the viability of a cluster randomised controlled trial of the effects of continuing medical education on whole-town diabetes monitoring and control.



Trial design: the cluster randomised controlled trial involved towns as the unit of allocation and analysis with outcomes assessed by de-identified pathology data (not reported here). The intervention programme consisted of an online active learning module, direct electronic access to specialist advice and performance feedback. Multiple rounds of invitation were used to engage GPs with the online intervention content. Evidence-based strategies (e.g. pre-notification, rewards, incentives) were incorporated into the invitations to enrol in the programme. Recruitment to the programme was electronically monitored through the hosting software package during the study intervention period.



Eleven matched pairs of towns were included in the study. There were 146 GPs in the 11 intervention towns, of whom 34 (23.3%) enrolled in the programme, and 8 (5.5%) completed the online learning module. No town had more than 10% of the resident GPs complete the learning module. There were no contacts made by GPs regarding requests for specialist advice. Consequently, the trial was discontinued.



There is an ongoing need to engage primary care physicians in improving diabetes monitoring and management in rural areas. Online training options, while notionally attractive and accessible, are not likely to have high levels of uptake, even when evidence-based recruitment strategies are implemented.



Australian New Zealand Clinical Trials Registry, identifier: ACTRN12611000553976 . Retrospectively registered on 31 May 2011.
Hunter Medical Research Institute, New Lambton Heights, Newcastle, NSW, Australia. Chris.Paul@newcastle.edu.au.|University of Newcastle, School of Medicine and Public Health, Callaghan, NSW, Australia. Chris.Paul@newcastle.edu.au.|W4 HMRI Building, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, 2308, Australia. Chris.Paul@newcastle.edu.au.
Christine L
CL
Paul
Monash University, School of Rural Health, Churchill, VIC, Australia.|Eastern Victoria General Practice Training, Churchill, VIC, Australia.
Leon
L
Piterman
Baker IDI Heart and Diabetes Institute, Clinical Diabetes and Epidemiology Group, Melbourne, VIC, Australia.|Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
Jonathan E
JE
Shaw
Monash University, School of Rural Health, Churchill, VIC, Australia.|Eastern Victoria General Practice Training, Churchill, VIC, Australia.
Catherine
C
Kirby
Hunter Medical Research Institute, New Lambton Heights, Newcastle, NSW, Australia.|University of Newcastle, School of Medicine and Public Health, Callaghan, NSW, Australia.
Kristy L
KL
Forshaw
Hunter Medical Research Institute, New Lambton Heights, Newcastle, NSW, Australia.
Jennifer
J
Robinson
Department of Community Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
Isaraporn
I
Thepwongsa
Hunter Medical Research Institute, New Lambton Heights, Newcastle, NSW, Australia.|University of Newcastle, School of Medicine and Public Health, Callaghan, NSW, Australia.
Robert W
RW
Sanson-Fisher
D001291:Attitude of Health Personnel; D001315:Australia; D003194:Computer-Assisted Instruction / Q000379:methods*; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis / Q000628:therapy*; D004502:Education, Medical, Continuing / Q000379:methods*; D058005:General Practitioners / Q000193:education* / Q000523:psychology; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D020407:Internet; D058007:Physicians, Primary Care / Q000193:education* / Q000523:psychology; D035842:Research Subjects / Q000193:education* / Q000523:psychology; D019035:Rural Health Services; D018401:Sample Size
General practice; Medical education; Online education; Rural medicine; Type 2 diabetes