- Irene D Blackberry, research fellow in primary care1,
- John S Furler, senior research fellow1,
- James D Best, head of school2,
- Patty Chondros, biostatistician1,
- Margarite Vale, clinical associate professor3,
- Christine Walker, chief executive officer4,
- Trisha Dunning, chair in nursing5,
- Leonie Segal, foundation chair in health economics and social policy6,
- James Dunbar, director7,
- Ralph Audehm, general practitioner clinical director8,
- Danny Liew, director9,
- Doris Young, professor of general practice1
- 1General Practice and Primary Health Care Academic Centre, University of Melbourne, 200 Berkeley St, Carlton, VIC 3053, Australia
- 2Melbourne Medical School, University of Melbourne, Parkville, VIC, Australia
- 3Department of Medicine, St Vincent’s Hospital, University of Melbourne, Fitzroy, VIC, Australia
- 4Chronic Illness Alliance, Surrey Hills, VIC, Australia
- 5School of Nursing and Midwifery, Deakin University and Barwon Health, Geelong, VIC, Australia
- 6School of Population Health Division of Health Sciences, University of South Australia, North Terrace, SA, Australia
- 7Greater Green Triangle, University Department of Rural Health, Flinders University and Deakin University, Warrnambool, VIC, Australia
- 8Dianella Community Health, Broadmeadows, VIC, Australia
- 9Melbourne EpiCentre, University of Melbourne, Royal Melbourne Hospital, Parkville, VIC, Australia
- Correspondence to: I D Blackberry
- Accepted 16 August 2013
Objective To evaluate the effectiveness of goal focused telephone coaching by practice nurses in improving glycaemic control in patients with type 2 diabetes in Australia.
Design Prospective, cluster randomised controlled trial, with general practices as the unit of randomisation.
Setting General practices in Victoria, Australia.
Participants 59 of 69 general practices that agreed to participate recruited sufficient patients and were randomised. Of 829 patients with type 2 diabetes (glycated haemoglobin (HbA1c) >7.5% in the past 12 months) who were assessed for eligibility, 473 (236 from 30 intervention practices and 237 from 29 control practices) agreed to participate.
Intervention Practice nurses from intervention practices received two days of training in a telephone coaching programme, which aimed to deliver eight telephone and one face to face coaching episodes per patient.
Main outcome measures The primary end point was mean absolute change in HbA1c between baseline and 18 months in the intervention group compared with the control group.
Results The intervention and control patients were similar at baseline. None of the practices dropped out over the study period; however, patient attrition rates were 5% in each group (11/236 and 11/237 in the intervention and control group, respectively). The median number of coaching sessions received by the 236 intervention patients was 3 (interquartile range 1-5), of which 25% (58/236) did not receive any coaching sessions. At 18 months’ follow-up the effect on glycaemic control did not differ significantly (mean difference 0.02, 95% confidence interval −0.20 to 0.24, P=0.84) between the intervention and control groups, adjusted for HbA1c measured at baseline and the clustering. Other biochemical and clinical outcomes were similar in both groups.
Conclusions A practice nurse led telephone coaching intervention implemented in the real world primary care setting produced comparable outcomes to usual primary care in Australia. The addition of a goal focused coaching role onto the ongoing generalist role of a practice nurse without prescribing rights was found to be ineffective.
Trial registration Current Controlled Trials ISRCTN50662837.
We thank the general practitioners, practice nurses, and patients who participated in the study, and the advisory group, consumer group, research higher degree students, Kitty Novy, and other research assistants who were committed to this study.
Contributors: All authors conceived and designed the study, implemented the trial, and contributed to data analysis and interpretation. IDB was the study coordinator and wrote the first draft of the manuscript. All authors contributed to subsequent drafts and approved the final version of the manuscript. DY is the principal investigator and acts as guarantor for the study.
Funding: This study was supported by the Australian National Health and Medical Research Council (ID 359374 and 566586). The funder was not involved in the study design, data collection, analysis, and interpretation.
Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare that: IDB, JSF, and PC received fellowship support from the Australian National Health and Medical Research Council Centre of Clinical Research Excellence in Diabetes for the submitted work; IDB, CW, PC, and MV received support from the National Health and Medical Research Council research grant for the submitted work; MV was the founder of The COACH Program; other authors have no relationships with any companies that might have an interest in the submitted work in the previous three years; DL and RA had financial relationships with pharmaceutical industries outside the submitted work; TD received royalties from a diabetes book and is a board member of the International Diabetes Federation and Diabetes Australia Victoria (voluntary capacity); and other authors have no non-financial interests that may be relevant to the submitted work.
Ethical approval: This study was approved by the University of Melbourne Human Research Ethics Committee (HREC 060123).
Data sharing: No additional data available.
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