Effectiveness of two procedures for deploying a facilitated collaborative modeling implementation strategy-the PVS-PREDIAPS strategy-to optimize type 2 diabetes prevention in primary care: the PREDIAPS cluster randomized hybrid type II implementation

Heather L Rogers, Alvaro Sanchez, Susana Pablo, Gonzalo Grandes, Prediaps Group

Keywords: Implementation science; collaborative modeling; interprofessional collaboration; health promotion; diabetes

Background:

The most efficient procedures to engage and guide healthcare professionals in collaborative processes that seek to optimize practice are unknown.

Research questions:

What is the effectiveness and feasibility of different procedures to perform a facilitated interprofessional collaborative process to optimize type 2 diabetes prevention in routine primary care?

Method:

A type II hybrid cluster randomized implementation trial was conducted in nine primary care centers of the Basque Health Service. All centers received training on effective healthy lifestyle promotion. A local leader and external facilitator lead centers through a collaborative structured process to adapt the intervention and its implementation to their specific context. The centers were randomly allocated. One group applied the implementation strategy globally, promoting the cooperation of all health professionals from the beginning. The other group performed it sequentially, centered first on nurses, who later sought cooperation from physicians.

Results:

After 12 months, 490 patients at risk of type 2 diabetes had their healthy lifestyles addressed in both comparison groups. The proportion of at-risk patients receiving a personalized prescription of lifestyle change was higher (8.6% vs 6.8%) and 2.3 times more likely in the sequential than in the global centers, after 8 months of the intervention program implementation period. The probability of meeting the recommended levels of physical activity and fruit and vegetable intake were four- and threefold higher after the prescription than only assessment and provision of advice. The procedure of engagement in and execution of the implementation strategy did not modify the effect of prescribing healthy habits (p > 0.05).

Conclusions:

The collaborative modeling implementation strategy integrates interventions with proven efficacy in the prevention of type 2 diabetes in clinical practice in primary care. Implementation outcomes were somewhat better using a sequential facilitated collaborative process focused on enhancing the autonomy and responsibility of nurses who subsequently seek a pragmatic cooperation of GPs.

Points for discussion:

What is the role of primary care nurses, and specifically in prevention activities, in your country?

Would you expect the results to be different if this study were implemented in your country or region?

How valuable do you perceive collaborative modelling to be in your context?

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