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Supporting care for suboptimally controlled type 2 diabetes mellitus in general practice with a clinical decision support system: a mixed methods pilot cluster randomised trial
  1. Mark E Murphy1,
  2. Jenny McSharry2,
  3. Molly Byrne2,
  4. Fiona Boland1,
  5. Derek Corrigan1,
  6. Paddy Gillespie3,
  7. Tom Fahey1,
  8. Susan M Smith1
  1. 1 Department of General Practice, HRB Centre for Primary Care Research, Royal College of Surgeons, Dublin, Ireland
  2. 2 Health Behaviour Change Research Group, School of Psycology, NUI Galway, Galway, Ireland
  3. 3 School of Business and Economics, National University of Ireland, Galway, Ireland
  1. Correspondence to Dr Mark E Murphy; markmurphy{at}rcsi.ie

Abstract

Objectives We developed a complex intervention called DECIDE (ComputeriseD dECisIonal support for suboptimally controlleD typE 2 Diabetes mellitus in Irish General Practice) which used a clinical decision support system to address clinical inertia and support general practitioner (GP) intensification of treatment for adults with suboptimally controlled type2 diabetes mellitus (T2DM). The current study explored the feasibility and potential impact of DECIDE.

Design A pilot cluster randomised controlled trial.

Setting Conducted in 14 practices in Irish General Practice.

Participants The DECIDE intervention was targeted at GPs. They applied DECIDE to patients with suboptimally controlled T2DM, defined as a glycated haemoglobin (HbA1c) ≥70 mmol/mol and/or blood pressure ≥150/95 mmHg.

Intervention The intervention incorporated training and a web-based clinical decision support system which supported; (i) medication intensification actions; and (ii) non-pharmacological actions to support care. Control practices delivered usual care.

Primary and secondary outcome measures Feasibility and acceptability was determined using thematic analysis of semi-structured interviews with GPs, combined with data from the DECIDE website. Clinical outcomes included HbA1c, medication intensification, blood pressure and lipids.

Results We recruited 14 practices and 134 patients. At 4-month follow-up, all practices and 114 patients were followed up. GPs reported finding decision support helpful navigating increasingly complex medication algorithms. However, the majority of GPs believed that the target patient group had poor engagement with GP and hospital services for a range of reasons. At follow-up, there was no difference in glycaemic control (−3.6 mmol/mol (95% CI −11.2 to 4.0)) between intervention and control groups or in secondary outcomes including, blood pressure, total cholesterol, medication intensification or utilisation of services. Continuation criteria supported proceeding to a definitive randomised trial with some modifications.

Conclusion The DECIDE study was feasible and acceptable to GPs but wider impacts on glycaemic and blood pressure control need to be considered for this patient population going forward.

Trial registration number ISRCTN69498919

  • diabetes & endocrinology
  • epidemiology
  • quality in health care
  • primary care
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This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

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Footnotes

  • Twitter @drmarkmurphy, @jenmcsharry

  • Contributors All authors contributed to the drafting of this paper. MEM, SMS and TF conceived of the study idea. MB guided MEM through the Behaviour Change Wheel theoretical model. MB and JM supported theoretical development of the study and the process evaluation. MEM conducted the semi-structured interviews; MEM and JM analysed the qualitative data. MEM conducted the statistical analysis with support from FB and SMS. DC supported the development and maintenance of the DECIDE website and clinical decision support system. PG supported the pilot health economic evaluation.

  • Funding This work was supported by the Health Research Board (HRB) Centre for Primary Care Research grant number: HRC-2014-1.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Ethical approval was granted by the Irish College of General Practitioners (ICGP).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request. All data from the study (.dta and .xls files) can be shared upon reasonable request.

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