PMID- 28915897 OWN - NLM STAT- MEDLINE DCOM- 20180601 LR - 20240327 IS - 1748-5908 (Electronic) IS - 1748-5908 (Linking) VI - 12 IP - 1 DP - 2017 Sep 16 TI - Development of a complex intervention to promote appropriate prescribing and medication intensification in poorly controlled type 2 diabetes mellitus in Irish general practice. PG - 115 LID - 10.1186/s13012-017-0647-z [doi] LID - 115 AB - BACKGROUND: Poorly controlled type 2 diabetes mellitus (T2DM) can be seen as failure to meet recommended targets for management of key risk factors including glycaemic control, blood pressure and lipids. Poor control of risk factors is associated with significant morbidity, mortality and healthcare costs. Failure to intensify medications for patients with poor control of T2DM when indicated is called clinical inertia and is one contributory factor to poor control of T2DM. We aimed to develop a theory and evidence-based complex intervention to improve appropriate prescribing and medication intensification in poorly controlled T2DM in Irish general practice. METHODS: The first stage of the Medical Research Council Framework for developing and evaluating complex interventions was utilised. To identify current evidence, we performed a systematic review to examine the effectiveness of interventions targeting patients with poorly controlled T2DM in community settings. The Behaviour Change Wheel theoretical approach was used to identify suitable intervention functions. Workshops, simulation, collaborations with academic partners and observation of physicians were utilised to operationalise the intervention functions and design the elements of the complex intervention. RESULTS: Our systematic review highlighted that professional-based interventions, potentially through clinical decision support systems, could address poorly controlled T2DM. Appropriate intensification of anti-glycaemic and cardiovascular medications, by general practitioners (GPs), for adults with poorly controlled T2DM was identified as the key behaviour to address clinical inertia. Psychological capability was the key driver of the behaviour, which needed to change, suggesting five key intervention functions (education, training, enablement, environmental restructuring and incentivisation) and nine key behaviour change techniques, which were operationalised into a complex intervention. The intervention has three components: (a) a training program/academic detailing of target GPs, (b) a remote finder tool to help GPs identify patients with poor control of T2DM in their practice and (c) A web-based clinical decision support system. CONCLUSIONS: This paper describes a multifaceted process including an exploration of current evidence and a thorough theoretical understanding of the predictors of the behaviour resulting in the design of a complex intervention to promote the implementation of evidence-based guidelines, through appropriate prescribing and medication intensification in poorly controlled T2DM. FAU - Murphy, Mark E AU - Murphy ME AD - HRB Centre for Primary Care Research, Royal College of Surgeons, Dublin, Ireland. markmurphy@rcsi.ie. FAU - Byrne, Molly AU - Byrne M AD - Health Behaviour Change Research Group, School of Psychology, National University of Ireland, Galway, Ireland. FAU - Zarabzadeh, Atieh AU - Zarabzadeh A AD - HRB Centre for Primary Care Research, Royal College of Surgeons, Dublin, Ireland. FAU - Corrigan, Derek AU - Corrigan D AD - HRB Centre for Primary Care Research, Royal College of Surgeons, Dublin, Ireland. FAU - Fahey, Tom AU - Fahey T AD - HRB Centre for Primary Care Research, Royal College of Surgeons, Dublin, Ireland. AD - HRB Centre for Primary Care Clinical Trials Network, Dublin, Ireland. FAU - Smith, Susan M AU - Smith SM AD - HRB Centre for Primary Care Research, Royal College of Surgeons, Dublin, Ireland. AD - HRB Centre for Primary Care Clinical Trials Network, Dublin, Ireland. LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20170916 PL - England TA - Implement Sci JT - Implementation science : IS JID - 101258411 RN - 0 (Hypoglycemic Agents) SB - IM MH - Diabetes Mellitus, Type 2/*drug therapy MH - General Practice/*methods MH - Humans MH - Hypoglycemic Agents/*therapeutic use MH - Ireland MH - *Practice Patterns, Physicians' MH - Primary Health Care/methods PMC - PMC5602930 OTO - NOTNLM OT - Appropriate prescribing OT - Behaviour Change Wheel OT - General practice OT - Health services research OT - Implementation OT - Professional intervention OT - Quality improvement OT - Type 2 diabetes mellitus COIS- ETHICS APPROVAL AND CONSENT TO PARTICIPATE: The Irish College of General Practitioners Research Ethics Committee have granted ethical approval to move to a pilot study of the DECIDE intervention. CONSENT FOR PUBLICATION: Not applicable. COMPETING INTERESTS: The authors declare that they have no competing interests. PUBLISHER'S NOTE: Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. EDAT- 2017/09/17 06:00 MHDA- 2018/06/02 06:00 PMCR- 2017/09/16 CRDT- 2017/09/17 06:00 PHST- 2017/02/15 00:00 [received] PHST- 2017/09/11 00:00 [accepted] PHST- 2017/09/17 06:00 [entrez] PHST- 2017/09/17 06:00 [pubmed] PHST- 2018/06/02 06:00 [medline] PHST- 2017/09/16 00:00 [pmc-release] AID - 10.1186/s13012-017-0647-z [pii] AID - 647 [pii] AID - 10.1186/s13012-017-0647-z [doi] PST - epublish SO - Implement Sci. 2017 Sep 16;12(1):115. doi: 10.1186/s13012-017-0647-z.