Evaluation and assessment of the usefulness of a mail delivered personalised diabetes information booklet and the association of non-response with clinical risk: the WICKED Project

Syed MR Gillani, A Nevill, Baldev M Singh

Abstract


Introduction: Patient activation can promote partnership working between people with diabetes and their healthcare professionals. We sent to people with diabetes a personalised, structured information booklet containing the results of their latest nine key care processes in order to inform and activate them. We present the findings of a survey to assess the utility of this report, with an analysis of the association of non-response to the survey, a surrogate for poorer patient activation, with adverse diabetes and clinical outcomes.

Methods: All 14,559 people with diabetes in the Wolverhampton health economy received a mailed report of the results of their latest nine diabetes care processes. Of these, 6,282 patients aged <75 years were mailed this report twice; 1000 of these 6,282 patients were selected randomly to receive a structured questionnaire to assess the report’s effectiveness.

Results: Of 1,000 patients, 419 (42%) responded (mean age 62±10 years, 246 males, 249 Caucasians, 389 had type 2 diabetes). Patients found this report useful (89%), a source of knowledge (78%), a source of increased confidence (74%) and it helped them understand their diabetes (78%). Non-response was associated with significantly higher surrogate markers of micro- and macrovascular risk.

Conclusion: A structured and personalised diabetes report, without direct professional or health service intervention, may improve the understanding and confidence of people with diabetes in their self-care and it may help to activate them to take a stronger partnership role in their health care. Non-response as a marker of patient activation is associated with increased clinical risk.

Keywords


care delivery, patient activation, patient engagement, information provision, diabetes

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References


World Health Statistics. Geneva: World Health Organisation, 2012. Available at: http://apps.who.int/iris/bitstream/10665/70889/1/WHO_IER_HSI_12.1_eng.pdf?ua=1 (last accessed Jan 2015).

Cayton H. Patient engagement and patient decision-making in England. The Commonwealth Fund/The Nuffield Trust, 2004. Available at: http://www.commonwealthfund.org/usr_doc/cayton_patientengland_735.pdf (last accessed Jan 2015).

Department of Health. Self Care – A Real Choice; Self Care Support – A Practical Option. London, 2005. Available at: http://webarchive.nationalarchives.gov.uk/20130107105354/http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_4101702.pdf (last accessed Jan 2015).

Department of Health. High Quality Care for All: NHS Next Stage Review Final Report. London, 2008. Available at: http://webarchive.nationalarchives.gov.uk/20130107105354/http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_085828.pdf (last accessed Feb 2015).

Eaton S, Walker R. Partners in Care: A Guide to Implementing a Care Planning Approach to Diabetes Care 2008. Available from: http://www.yearofcare.co.uk/sites/default/files/images/partners%20in%20care%20implementing%20care%20planning%20approach.pdf (last accessed Feb 2015).

Department of Health. The Expert Patient: A New Approach to Chronic Disease Management for the 21st Century. London, 2001. Available at: http://webarchive.nationalarchives.gov.uk/20130107105354/http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_4018578.pdf (last accessed Feb 2015).

Department of Health and Diabetes UK Care Planning Working Group. Care Planning in Diabetes. London, 2006. Available at: http://www.diabetes. org.uk/documents/reports/careplanningdec06.pdf (last accessed Feb 2015).

Chatterjee JS. From compliance to concordance in diabetes. J Med Ethics 2006;32:507–10. http://dx.doi.org/10.1136/jme.2005.012138

Department of Health. Our Health, Our Care, Our Say: A new direction for community services; Health and social care working together in partnership (White Paper). London, 2006. Available at: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/272238/6737.pdf (last accessed Feb 2015).

Remmers C, Hibbard J, Mosen DM, et al. Is patient activation associated with future health outcomes and healthcare utilization among patients with diabetes? J Ambul Care Manage 2009;32:320–7. http://dx.doi/org/10.1097/JAC.0b013e3181ba6e77

Wong CK, Wong WC, Lam CL, et al. Effects of Patient Empowerment Programme (PEP) on clinical outcomes and health service utilization in type 2 diabetes mellitus in primary care: an observational matched cohort study. PLoS One 2014;9:e95328. http://dx.doi.org/10.1371/journal.pone.0095328

Health and Social Care Information Centre/Diabetes UK. National Diabetes Audit 2011–12 Report. Report 1: Care Processes and Treatment Targets. 2012. Available at: http://www.hscic.gov.uk/catalogue/PUB12421/nati-diab-audi-11-12-care-proc-rep.pdf (last accessed Feb 2015).

Loveman E, Frampton GK, Clegg AJ. The clinical effectiveness of diabetes education models for type 2 diabetes: a systematic review. Health Technol Assess 2008;12:1–116. http://dx.doi.org/10.3310/hta12090

Newbould J, Burt J, Bower P, et al. Experiences of care planning in England: interviews with patients with long term conditions. BMC Fam Pract 2012;13:71. http://dx.doi.org/10.1186/1471-2296-13-71

Parchman ML, Zeber JE, Palmer RF. Participatory decision making, patient activation, medication adherence, and intermediate clinical outcomes in type 2 diabetes: a STARNet study. Ann Fam Med 2010;8:410–17. http://dx.doi.org/ 10.1370/afm.1161

Greenfield S, Kaplan SH, Ware JE Jr, et al. Patients' participation in medical care: effects on blood sugar control and quality of life in diabetes. J Gen Intern Med 1988;3:448–57. http://dx.doi.org/10.1007/BF02595921

Doherty Y, Eaton S, Turnbull R, et al. Year of Care: the key drivers and theoretical basis for a new approach in diabetes care. Practical Diabetes 2012;29:183–6. http://dx.doi.org/10.1002/pdi.1687

Kidd J, Marteau TM, Robinson S, et al. Promoting patient participation in consultations: a randomised controlled trial to evaluate the effectiveness of three patient-focused interventions. Patient Educ Couns 2004; 52:107–12. http://dx.doi.org/10.1016/S0738-3991(03)00018-1

Estabrooks PA, Nelson CC, Xu S, et al. The frequency and behavioral outcomes of goal choices in the self-management of diabetes. Diabetes Educ 2005;31:391–400. http://dx.doi.org/10.1177/0145721705276578

Renders CM, Valk CM, Griffin SJ, et al. Interventions to improve the management of diabetes in primary care, outpatient, and community settings, a systematic review. Diabetes Care 2001;24:1821–33. http://dx.doi.org/10.2337/diacare.24.10.1821

O'Connor PJ, Desai J, Solberg LI, et al. Randomized trial of quality improvement intervention to improve diabetes care in primary care settings. Diabetes Care 2005;28:1890–7. http://dx.doi.org/10.2337/diacare.28.8.1890

Hong YY, Lim YY, Audrey Lim SY, et al. Providing diabetes patients with personalized written clinical information in the diabetes outpatient clinic: a pilot study. Diabet Med 2010;27:685–90. http://dx.doi.org/10.1111/j.1464-5491.2010.03008

Tusting K, Barton D. Models of adult learning: a literature review. Leicester: NIACE, 2006.

Weinman J. Providing written information for patients: psychological considerations. J R Soc Med 1990;83:303–05.

Gillani SM, Singh BM. A simple method for introducing care planning into specialist diabetes clinics. The WICKED project. Practical Diabetes 2014;31:337–41. http://dx.doi.org/10.1002/pdi.1898

Gillani SMR, Nevill A, Singh BM. Provision of structured diabetes information encourages activation amongst people with diabetes as measured by diabetes care process attainment: the WICKED Project. Diabet Med 2015;32:865–71. http://dx.doi.org/ 10.1111/dme.12737

Kirkpatrick, Donald L. "Techniques for evaluating training programs”. Classic writings on instructional technology 1.192 (1996):119.

Asch DA, Jedrziewski MK, Christakis NA. Response rates to mail surveys published in medical journals. J Clin Epidemiol 1997;50:1129–36. http://dx.doi.org/10.1016/S0895-4356(97)00126-1

Edwards P, Roberts I, Clarke M, et al. Methods to increase response rates to postal questionnaires. Cochrane Database Syst Rev 2007;(2): MR000008. http://dx.doi.org/10.1002/14651858.mr000008.pub3

Etter, J-F, Perneger TV. Analysis of non-response bias in a mailed health survey. J Clin Epidemiol 1997;50:1123–28. http://dx.doi.org/10.1016/S0895-4356(97)00166-2

Melton LJ, Dyck PJ, Kames JL, O’Brien PC, Service FJ. Non-response bias in studies of diabetic complications: the Rochester Diabetic Neuropathy Study. J Clin Epidemiol 1993;46:341–8. http://dx.doi.org/10.1016/0895-4356(93)90148-T

Gillani SMR, Nayak AU, Thiruvenkatasamy K, et al. A method to validate the accuracy of a centralised district diabetes register. Practical Diabetes 2013;30:224–8. http://dx.doi.org/10.1002/pdi.1780

Hibbard J, Gilburt H. Supporting People to Manage their Health: An Introduction to Patient Activation. London: King’s Fund, 2014. Available from: http://www.kingsfund.org.uk/sites/files/kf/field/field_publication_ file/supporting-people-manage-health-patient-activation-may14.pdf (last accessed October 2015).

Gillani SMR, Holland MR, Sidhu M, Singh BM. A case control study of use of the Failed Access Score for determination of failed access to structured diabetes care: the WICKED Project. Practical Diabetes 2014; 31:107–10. http://dx.doi.org/10.1002/pdi.1843

Donald M, Ware RS, Ozolins IZ, et al. The role of patient activation in frequent attendance at primary care: a population-based study of people with chronic disease. Patient Educ Couns 2011;83:217–21. http://dx.doi.org/10.1016/j.pec.2010.05.031

Brenk-Franz K, Hibbard JH, Herrmann WJ, et al. Validation of the German version of the Patient Activation Measure 13 (PAM13-D) in an international multicentre study of primary care patients. PLoS One 2013;8:e74786. http://dx.doi.org/10.1371/journal.pone.0074786




DOI: https://doi.org/10.15277/bjd.2016.099

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