چکیده (انگلیسی):

Background:The Danish health care sector is reorganising based on disease management programmes designed
to secure integrated and high quality chronic care across hospitals, general practitioners and municipalities. The
disease management programmes assign a central role to general practice; and in the Capital Region of Denmark a
facilitator-based intervention was undertaken to support the implementation of the programmes in general practice.
The purpose of the study was to assess the effectiveness of this semi-tailored facilitator-based intervention.
Method:The study was a stepped-wedge, randomised, controlled trial among general practices in the Capital
Region of Denmark. The intervention group was offered three one-hour visits by a facilitator. The intervention was
semi-tailored to the perceived needs as defined by each general practice, and the practices could choose from a list of
possible topics. The control group was a delayed intervention group. The primary outcome was change in the number
of annual chronic disease check-ups. Secondary outcomes were: changes in the number of annual check-ups for type 2
diabetes (DM2) and chronic obstructive pulmonary disease (COPD); changes in the number of spirometry tests, changes
in the use of ICPC diagnosis coding and patient stratification; sign-up for a software program for patient overview; and
reduction in number of practices with few annual chronic disease check-ups.
Results:We randomised 189 general practices: 96 practices were allocated to the intervention group and 93 to the
delayed intervention group. For the primary outcome, 94and 89 practices were analysed. Almost every outcome
improved from baseline to follow-up in both allocation groups. At follow-up there was no difference between
allocation groups for the primary outcome (p = 0.1639). However, some secondary outcomes favoured the intervention:
a higher reported use of ICPC diagnosis coding for DM2 and COPD (p = 0.0050, p = 0.0243 respectively), stratification
for COPD (p = 0.0185) and a faster initial sign-up rate for the software program.
Conclusion:The mixed results from this study indicate that a semi-tailored facilitator-based intervention of relatively
low intensity is unlikely to add substantially to the implementation of disease management programmes for DM2 and
COPD in a context marked by important concurrent initiatives (including financial incentives and mandatory registry
participation) aimed at moving all practices towards changes in chronic care.
Trial registration:ClinicalTrials.gov: NCT01297075