Patient Activation Through Community Empowerment/Engagement for Diabetes Management (PACE-D)

NCT ID: NCT04288362

Last Updated: 2022-04-26

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

1620 participants

Study Classification

INTERVENTIONAL

Study Start Date

2019-03-25

Study Completion Date

2022-03-31

Brief Summary

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The study is a non-randomised controlled trial involving an intervention group and a control group. It aims to evaluate the effects of a patient engagement and empowerment model of collaborative care support planning on clinical outcomes of patients with diabetes mellitus as compared to usual care in the primary care setting. It also aims will be to examine the impact of the intervention on patient activation, patient and healthcare provider experience, and healthcare utilisation.

Detailed Description

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The investigators will conduct a prospective study on existing patients with diabetes who are on follow-up with their teamlets at Pioneer (PIO), Jurong (JUR), Bukit Batok (BBK) and Choa Chu Kang (CCK) polyclinics for management of diabetes. Recruitment will occur for 18 months from the time of study implementation. One teamlet in JUR and one teamlet in PIO (total of two teamlets) will fall under intervention arm where the new care model based on the Year-of-Care (YOC) model will be delivered, whereas one teamlet in BBK and one teamlet in CCK (total of another two teamlets) will fall under the control arm where the current teamlet model will be continued.

In the intervention group, patients recruited will undergo the new care model which entails receiving the Care Planning Results Letter before the consultation at their annual review, involving them in the Care and Support Planning (CSP) consultation at the annual review, and referring them to suitable community resources to support self-management. The Care Planning Results Letter prompts patients to think the issues they would like to raise to their Doctor or Care Manager (who is a nurse trained in chronic disease management), checks on their mood, provides information on their most recent few laboratory test results, clinical parameters, smoking status, and attendances for foot and eye screenings. The letter also covers goal setting and action planning discussions. The patient is expected to bring it for the upcoming CSP consultation at the annual review. The CSP is a conversation which is conducted by the Doctor or Care Manager trained in the new care model. It focuses on a collaborative approach between the health care providers and the patient for joint goal setting and shared decision making to support self-management of their chronic condition(s).

In the control arm, the participants will receive the usual care with the teamlet model. There will not be any Care Planning Results Letter prepared for the patient. At the upcoming annual visit, the patient will continue to have the usual annual review for the laboratory test results and consultation. A flyer that lists the community programmes that support the patient for self-management will also be issued to the patient. If the patient is interested in any of these programmes, they may sign up with the respective community providers directly.

After the first CSP, selected patient participants may be invited for a one-to-one in-depth interviews (IDIs) to explore their perceptions about diabetes, diabetes management and the intervention programme in greater detail. The interviews will be conducted by researchers trained qualitative research methodology. They will be semi-structured with a topic guide to support exploration of the themes of interest, and will be informed by prior qualitative research with this and other similar interventions, as well as the results from the patient surveys. Health care providers who are involved in the delivery of CSPs in the intervention arm will also be invited for a one-to-one in-depth interviews (IDIs), to develop an understanding of how they find the training and new way of working with patients (particularly the care and support planning conversation).

Conditions

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Diabetes Mellitus Chronic Disease Patient Care Planning Patient Participation Self Care Empowerment

Study Design

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Allocation Method

NON_RANDOMIZED

Intervention Model

PARALLEL

Non-randomised controlled trial
Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Intervention Group

Group Type EXPERIMENTAL

Intervention Group

Intervention Type OTHER

Participants in this arm will undergo the new care model for management of diabetes mellitus polyclinics.

Control Group

Group Type ACTIVE_COMPARATOR

Control Group

Intervention Type OTHER

Participants in this arm will continue to undergo the existing care model for management of diabetes mellitus in the polyclinics.

Interventions

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Intervention Group

Participants in this arm will undergo the new care model for management of diabetes mellitus polyclinics.

Intervention Type OTHER

Control Group

Participants in this arm will continue to undergo the existing care model for management of diabetes mellitus in the polyclinics.

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

* On follow up with an existing teamlet pre-assigned to participate in the study
* Adults with diabetes mellitus
* Age 21 years and above
* Ability to provide informed consent
* Ability to communicate in the language(s) which the physician is confident to carry out the care and support planning consult in English, Malay or Chinese
* Ability to read and comprehend the Diabetes Results Letter on their own OR has family members who are able to assist to that

Exclusion Criteria

* Doctors, Care Managers and Care Coordinators involved in the care and support planning process
* Age 21 years and above
* Ability to provide informed consent
Minimum Eligible Age

21 Years

Maximum Eligible Age

99 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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National University Hospital, Singapore

OTHER

Sponsor Role collaborator

National University of Singapore

OTHER

Sponsor Role collaborator

National University Health System, Singapore

OTHER

Sponsor Role lead

Responsible Party

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Tan Wee Hian

PACE-D Programme Director, Consultant Family Physician

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Doris Young

Role: STUDY_CHAIR

National University Health System, Singapore

Victor Weng Keong Loh

Role: STUDY_DIRECTOR

National University Health System, Singapore

Tong Wei Yew

Role: STUDY_DIRECTOR

National University Hospital, Singapore

Kavita Venkataraman

Role: STUDY_DIRECTOR

National University of Singapore

Brent Gibbons

Role: STUDY_DIRECTOR

National University of Singapore

Vikki Entwistle

Role: STUDY_DIRECTOR

National University of Singapore

Soon Guan Tan

Role: STUDY_DIRECTOR

National University of Singapore

Meena Sundram

Role: STUDY_DIRECTOR

National University Health System, Singapore

Keith Tsou

Role: STUDY_DIRECTOR

National University Health System, Singapore

Yii Jen Lew

Role: STUDY_DIRECTOR

National University Health System, Singapore

Wee Hian Tan

Role: PRINCIPAL_INVESTIGATOR

National University Health System, Singapore

Locations

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National University Polyclinics

Singapore, , Singapore

Site Status

Countries

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Singapore

References

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Coulter A, Entwistle VA, Eccles A, Ryan S, Shepperd S, Perera R. Personalised care planning for adults with chronic or long-term health conditions. Cochrane Database Syst Rev. 2015 Mar 3;2015(3):CD010523. doi: 10.1002/14651858.CD010523.pub2.

Reference Type BACKGROUND
PMID: 25733495 (View on PubMed)

Wagner EH, Austin BT, Von Korff M. Organizing care for patients with chronic illness. Milbank Q. 1996;74(4):511-44.

Reference Type BACKGROUND
PMID: 8941260 (View on PubMed)

Bodenheimer T, Wagner EH, Grumbach K. Improving primary care for patients with chronic illness: the chronic care model, Part 2. JAMA. 2002 Oct 16;288(15):1909-14. doi: 10.1001/jama.288.15.1909.

Reference Type BACKGROUND
PMID: 12377092 (View on PubMed)

Hibbard JH, Stockard J, Mahoney ER, Tusler M. Development of the Patient Activation Measure (PAM): conceptualizing and measuring activation in patients and consumers. Health Serv Res. 2004 Aug;39(4 Pt 1):1005-26. doi: 10.1111/j.1475-6773.2004.00269.x.

Reference Type BACKGROUND
PMID: 15230939 (View on PubMed)

Tan WH, Loh VWK, Venkataraman K, Choong ST, Lew YJ, Sundram M, Tsou K, Tan SG, Gibbons B, Entwistle V, Young D, Tai ES, Yew TW. The Patient Activation through Community Empowerment/Engagement for Diabetes Management (PACE-D) protocol: a non-randomised controlled trial of personalised care and support planning for persons living with diabetes. BMC Fam Pract. 2020 Jun 19;21(1):114. doi: 10.1186/s12875-020-01173-2.

Reference Type DERIVED
PMID: 32560689 (View on PubMed)

Other Identifiers

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CS-SN-03

Identifier Type: -

Identifier Source: org_study_id

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