JOURNAL READING

OLEH :
E K A F E B I YA N T O
KHAUL AH KARIMAH
R E V I L I FA R D I A N A

K L I N I K P RATA M A F I R D A U S
GENERAL PRACTICE AND SOCIAL SERVICE PARTNERSHIP FOR
BETTER CLINICAL OUTCOMES, PATIENT SELF EFFICACY AND
LIFESTYLE BEHAVIOURS OF DIABETIC CARE: RANDOMISED
CONTROL TRIAL OF A CHRONIC CARE MODEL

A L B E RT L E E , C H O I - F O N G S I U , K A M -TA O
L E U N G , L O U I S A C H L A U , C AT H Y C M C H A N , K W O K-
KEUNG WONG
 JOURNAL RESUME

Author :
Albert Lee,Choi-Fong Siu,Kam-Tao Leung,Louisa C H
Lau, Cathy C M Chan,Kwok-Keung Wong
 OBJECTIVE

Aims to evaluate the effectiveness of the diabetes

mellitus (DM) self management programme, with
partnership between general practice and social
work, on clinical outcomes, patient self efficacy
and lifestyle behaviours.
 TIME AND PLACE

2011
2011

General outpatient
clinics in the
Hospital Authority
New Territory East
Cluster of Hong
Kong
RESEARCH DESIGN

Singleblind
Single blind
randomised
randomised
controlled trial
controlled trial
 PICO
Effectiveness of the diabetes mellitus (DM) self
Problem
management programme on clinical outcomes,
patient self efcacy and lifestyle behaviours.

The patients received their usual medical follow-ups

in their general outpatient clinics (GOPCs) and
Intervention underwent six sessions of a weekly DM self
management course
The patients only received their usual medical follow-
Comparrison ups in their general outpatient clinics (GOPCs).

There is no signicant differences on clinical

Outcome
outcomes, patient self efcacy and lifestyle
behaviours.
 METHODS

Inclussion :
Patients with unstable DM control: last
HbA1c 7% or greater, capable of lling in
study diary, capable of giving informed
written consent.
Exclussion :
Subjects with cognitive impaiment & can
communicate with others.
 INTERVENTION
Effectiveness of the diabetes
mellitus (DM) self
management programme on
clinical outcomes, patient self
efcacy and lifestyle
behaviours.
The patients received their
usual medical follow-ups in
their general outpatient
clinics (GOPCs) and
underwent six sessions of a
weekly DM self management
course
The patients only received
their usual medical follow-ups
in their general outpatient
clinics (GOPCs).
 OUTCOMES

There is no signicant differences between

experimental and control group on clinical
outcomes, patient self efcacy and lifestyle
behaviours.
RESULTS
 CONCLUSIONS

This randomised controlled trial of diabetes self

management concentrating on self efcacy and
development of a healthy behavioural model has
demonstrated statistically signicant changes in clinical
outcomes and health behaviours in the experimental group.
Energy and effort should be invested in patient self
management to support patients to live with the best
possible control of their chronic condition GPs should
reinforce self management to avoid patients with chronic
illnesses socialised into the medical model fostering a
dependence on professionals, and should also advocate for
patients to appeal to healthcare providers and health
insurers to include patient self management as part of
formal healthcare.
 INTERNAL VALIDITY
In a well conducted RCT study Does this study do it?
1.1 The study addresses an appropriate and clearly Yes
focused question
1.2 The assignment of subjects to treatment groups is Yes
randomised
1.3 An adequate concealment method is used

1.4 The design keeps subjects and investigators blind Yes

about treatment allocation
1.5 The treatment and control groups are similar at the Yes
start of the trial
1.6 The only difference between groups is the treatment Yes
under investigation
1.7 All relevant outcomes are measured in a standard, Yes
valid and reliable way
1.8 What percentage of the individuals or clusters 8.9%
recruited into each treatment arm of the study dropped
out before the study was completed?
1.9 All the subjects are analysed in the groups to which Yes
they were randomly allocated (often referred to as
intention to treat analysis)
1.1 Where the study is carried out at more than one site, Does not apply
 OVERALL ASSESSMENT OF THE STUD
2.1 How well was the study done to High quality (+
minimize bias? +)

2.2 Taking into account clinical considerations, your evaluation of Yes, p<0,001
the methodology used, and the statistical power of the study,
are you certain that the overall effect is due to the study
intervention?

2.3 Are the results of this study directly applicable to the patient Yes
group targeted by this guideline?

2.4 This study was a randomised control trial with single blinded data analysis, subjects were
recruited from patients attending general outpatient clinics in the Hospital Authority New
Territory East Cluster of Hong Kong. 157 subjects meeting the inclusion criteria completed the
study and were randomly assigned to the experimental or control group. The experimental
group underwent the six sessions of weekly DM self management course with emphasis on
self efcacy and participatory approach. The outcome measurements included HbA1c
concentration, DM self efcacy scale, dietary behaviours, body mass index (BMI), and waist:
hip ratio. Baseline assessment observed no signicant differences between experimental and
control groups for the variables related to outcomes. For the experimental group, the
proportion of subjects with normal HbA1c increased from 4.5% (3/66) at baseline to 28.6%
(19/66) at week 28 (p<0.001), but there was insignicant improvement in the control group
(3.9% to 11.8%, p0.13). Repeated measure of analysis of variance showed pronounced
improvement in DM self efcacy scale and BMI among the experimental group with signicant
interaction. Dietary behaviours also improved signicantly in the experimental group
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