Process evaluation of team-based care in people aged >65 years with type 2 diabetes mellitus.
OBJECTIVE
The prevalence of type 2 diabetes mellitus (T2DM) is increasing globally and there is critical need develop interventions to improve health outcomes among older people. The Group Appointments in Primary Care (GAP) study was a randomised controlled trial designed to test the efficacy of a group and team-based medical visit programme to lower haemoglobin A1c among patients with T2DM. We aimed to understand the barriers and facilitators to implement the GAP intervention within a primary care setting, with an emphasis on patient experience.


RESEARCH DESIGN AND METHODS
This was a qualitative exploratory study. Data were gathered from semistructured interviews conducted with the first cohort of GAP study participants (n=15) at baseline and intervention completion. GAP participants were aged >65, diagnosed with T2DM and from one primary care clinic. The interview questions identified the patient perspectives and factors relating to their attendance at seven group medical visits that were part of the intervention programme. Data were analysed using framework analysis.


RESULTS
We identified four themes that captured participants' experiences: (1) Education: learning with professionals, learning with one another; (2) Social Support: common interests, common problems; (3) Setting: ease of location, ease of conversation and (4) Impact: expectations met, empowerment gained. The GAP intervention increased participants' self-reported diabetes literacy and self-management skills.


CONCLUSIONS
We learnt that: accessible community centres, not primary care offices, were the ideal location for GAP; the consistent leadership of the primary care physician was valued by participants; and, the content related to exercise and healthy diet were viewed as impactful. Also, learning was achieved through content delivered by clinical experts, and by T2DM experts with lived experience-the GAP peers. Our findings highlight the important role of group learning.


TRIAL REGISTRATION NUMBER
NCT02002143.
['Sims Gould|Joanie|J|0000-0003-1260-5405', 'Tong|Catherine|C|', 'Ly|Jessica|J|', 'Vazirian|Sara|S|', 'Windt|Adriaan|A|', 'Khan|Karim|K|']
D000368:Aged D000369:Aged, 80 and over D001955:British Columbia D003151:Community Health Centers D003924:Diabetes Mellitus, Type 2 D000072001:Diet, Healthy D015444:Exercise D006442:Glycated Hemoglobin A D006297:Health Services Accessibility D006801:Humans D007857:Leadership D007858:Learning D010348:Patient Care Team D010353:Patient Education as Topic D011320:Primary Health Care D017064:Process Assessment, Health Care D000075082:Proof of Concept Study D016037:Single-Blind Method D012944:Social Support
team-based care general diabetes geriatric medicine qualitative research