? Multiple studies have documented difficulties in adequate reduction of cardiovascular risk factors for patients with type 2 diabetes seen in primary care settings. Although more than 97% of adults with diabetes seek their care from a primary care physician, translating theoretically sound strategies that work in research settings into real world primary care practices has been a challenge. A number of specific strategies to improve the translation of existing knowledge into primary care practices have proven efficacy. At the level of the practice, pro-active patient care teams that use disease registries to improve care are efficacious. At the patient level, patient activation to increase the patients involvement in medical decision-making during the patient-physician encounter is efficacious. Although trials in a few settings support the efficacy of these two interventions, studies are needed to evaluate their effectiveness in reducing cardiovascular risk factors in diabetes across a variety of primary care settings and to test methods of implementation that result in a sustainable improvement. This proposal describes a planning grant project that will have as its ultimate goal the development of an R18 proposal for a full study of these two interventions to be submitted in response to the AHRQ/NIDDK Program Announcement """"""""Translational Research for the Prevention and Control of Diabetes (PA-02-153). This planning grant will be supported in part by a recently funded K08 award to the Principal Investigator from the Agency for Healthcare Research and Quality. In preparation for an R18 grant application, we propose to accomplish the following specific aims: 1)Establish a collaborative of primary care practice-based research networks for the purpose of developing an adequate 'population' of practices to sample from for the full study; 2)Develop and test methods to assemble and follow a cohort of diabetic patients within multiple independent small group primary care practices; 3)Test the feasibility of the proposed intervention in a small sample of primary care practices; 4) Assess outcome measures for feasibility, reliability, intra-and inter-practice variability, and responsiveness to intervention for purposes of sample size estimation; and 5) Prepare an R18 grant proposal for a randomized trial of both practice-level and patient-level interventions to reduce cardiovascular risk factors among adults with type 2 diabetes in primary care practice settings. ? ?
| Parchman, Michael L; Zeber, John E; Palmer, Raymond F (2010) Participatory decision making, patient activation, medication adherence, and intermediate clinical outcomes in type 2 diabetes: a STARNet study. Ann Fam Med 8:410-7 |
