Motivational interviewing embedded in planned diabetes care for Type 2...


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Titel Motivational interviewing embedded in planned diabetes care for Type 2 patients: effectiveness and efficiency in general practice especially to improve guideline recommendations on diet and exercise
Looptijd 02 / 2006 - onbekend
Status Afgesloten
Onderzoeknummer OND1318003
Leverancier gegevens ZONMW

Samenvatting (EN)

Objective: Improving Type 2 diabetes guideline adherence focussing on lifestyle changes by structuring the organisation of care and using the patient-oriented motivational interviewing (MI) technique. . Healthcare problem: Diabetes is globally a fast growing disease, due to aging and changes in lifestyle. In the Netherlands about half a million people are known to have diabetes and this number is expected to increase with 36% in the next 20 years [Van Oers 2002]. It is known that regular measurements recommended in the guidelines are only performed moderately. Outcomes are not always discussed while professionals do not have or reserve time to discuss these items with their patients or they do not act on deviant outcomes [Cook 1999] To improve Type 2 diabetes care according to the guidelines we will introduce an implementation strategy based on getting structured care in general practice supported by a practice nurse, who will be trained in motivational interviewing on diet and exercise. Lifestyle counselling is recommended in guidelines on diabetes care, but its implementation in daily practice is still a challenge. Providing the practice nurse with a tool for lifestyle counselling is seen as helpful in improving the adherence to guideline recommendations on diet and exercise. Motivational interviewing is a very promising approach to lifestyle counselling for diabetes patients that involves patients' in their own therapeutic management. We would like to determine the cost and effects of this strategy for implementation of the prevailing diabetes guidelines in a group of diabetes patients that can profit the most of it, i.e. Type 2 diabetes patients with a relatively high HbA1c (above 8.0%) and having problems with their weight (BMI above 25 kg/m2). It is assumed that the implementation strategy will lower the HbA1c and that diet activities as well as exercises will increase. At the same time the adherence to the other recommendations should not be diminished. The main research questions are: . Motivation chosen focus and contribution to the resolution of the healthcare problem: Adherence to diet and exercise recommendations in the diabetes Type 2 guidelines is very low. Type 2 diabetes is a disease of the elderly (mean age is 65 years) and most have overweight. Obesity has a lifetime impact on disability and morbidity (e.g. risk factor for diabetes complications). A decrease in obesity will lead to an increase in healthy life-years and in a decrease in direct and indirect health care costs [Visscher 2004]. . Level of change: The implementation strategy focuses on the improvement of quality of care for Type 2 diabetes patients in general practice focussing on diet and exercise by making the care delivered explicitly structured and by introducing a management tool. It is assumed that adherence to lifestyle counselling needs an extra tool to manage the patient care for overweighed patients. This tool is motivational interviewing. A key role in structuring diabetes care and using motivational interviewing is for the practice nurse. So, change is directed to the health professionals (general practitioner and practice nurse) (meso level), but it will also affect the health outcome of the Type 2 diabetes patient with a relatively high HbA1c and overweight and their process in getting these outcomes (micro level). . Analysis of the context: Usual diabetes care is hard to grasp. Besides all kind of local projects, the introduction of practice nurses, nurse practitioners (highly educated), physician assistances into general practice changed the diabetes care. However, practices vary a lot. Recent figures showed that one in four practices had in 2000 a nurse practitioner [van den Berg 2004]

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Projectleider Dr. J.C.C. Braspenning


A73100 Eerstelijnsgezondheidszorg
A76000 Patiƫntenzorg
D23220 Inwendige geneeskunde
D23380 Huisartsgeneeskunde

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