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

Conference: 
SAPC ASM 2020 - cancelled due to pandemic
Talk Code: 
F.11
Presenter: 
Mark Murphy
Twitter: 
@drmarkmurphy
Co-authors: 
Dr. Mark E Murphy, Dr. Jenny McSharry, Professor Molly Byrne, Dr. Fiona Boland, Dr. Derek Corrigan, Professor Paddy Gillespie, Professor Tom Fahey, Professor Susan Smith
Author institutions: 
HRB Centre for Primary Care Research, Royal College of Surgeons, Ireland. Health Behaviour Change Research Group, School of Psychology, National University of Ireland, Galway, Ireland. Health Economics & Policy Analysis Centre (HEPAC), National University of Ireland, Galway, Ireland.

Problem

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 GP intensification of treatment for adults with suboptimally controlled T2DM.

Approach

The current study explored the feasibility and potential impact of DECIDE, through a pilot cluster randomised controlled trial (RCT). Conducted in 14 practices in Irish General Practice, the DECIDE intervention was targeted at GPs. They applied DECIDE to patients with suboptimally controlled T2DM, defined as a HbA1c ≥ 70mmol/mol and /or BP ≥ 150/95 mmHg. 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. 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.

Findings

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 (-3.6mmol/mol (95% CI; -11.2, 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.

Consequences

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.

Submitted by: 
Mark Murphy
Funding acknowledgement: 
This work was supported by the Health Research Board (HRB) Centre for Primary Care Research grant number: HRC-2014-1. The authors would also like to acknowledge support from the HRB-funded SPHeRE PhD Programme (Grant code: 1598), a research grant from the Irish College of General Practitioners, the WestREN Research Network and the HRB Primary Care Clinical Trials Network Ireland (Grant Code: CTN-2014-011).