A randomised control trial to test an educational innovation of diabetes care in general practice

The aim is to assess the effectiveness of a tailored, adaptive, online spaced education program, Spaced Education Diabetes (SED), on improving the provision of evidence based management of type 2 diabetic patients by GPs. The researchers will be collecting two main data sets to evaluate the effectiveness of SED; data on GPs management of standardised type 2 diabetic patients (presented in video vignettes), and data on GPs management of real patients under their care. These data will be measured at baseline and then post-intervention. Upon recruitment, all participants will receive a copy of the NHMRC/ RACGP Handbook in Diabetes Care. Phase 1: Standardised patients - all participating GPs will view six video vignettes (2-4 minutes each) featuring an actor portraying patients with type 2 diabetes presenting to a GP. Vignettes will be accessible via a secure website, and the software used will allow GPs to view them at their own pace, and in their own time - GPs will have a maximum of 3 months to complete the fist six vignette scenarios. The vignettes will be adapted from the Spaced Education Diabetes (SED) program and will present patients who would benefit from a change in their current management. After viewing the videos, GPs will answer questions on whether they would prescribe (new drug or change therapy), investigate (order a test) or write a referral for the patient represented in the video. Participating practitioners will answer questions related to the further management of each ‘patient’ in the vignette, and this survey will demonstrate a baseline level of their knowledge of type 2 diabetes management. Real Patients - Upon recruitment, GPs will provide de-identified data on 30 type 2 diabetic patients under their care. Each patient will have three data values recorded over the study, for Body Mass Index (BMI), Blood Pressure (BP), glycated haemoglobin concentration (HbA1c), Low Density Lipoprotein Cholesterol (LDL-C), High Density Lipoprotein Cholesterol (HDL-C), triglycerides and total cholesterol results. Information on the patient’s current prescribed medication for the management of lipids, blood pressure and diabetes will also be recorded. This information will be used by the research team to generate comparisons between the baseline data and post-intervention data. It is envisaged that phase 1 will take 3 months. Phase 2: Standardised patients - GPs will be randomised in to two groups. GPs randomised to the control group will receive no further intervention and will be advised to continue with usual care. GPs randomised to the intervention group will receive the SED program, focusing on the implementation of guidelines for the management of blood pressure, lipids and glucose control in type 2 diabetes. SED will be delivered to GPs via email and will involve distribution of case studies with six multiple choice questions on the management of hyperglycaemia, hyperlipidaemia and hypertension in diabetes. Questions will be repeated after 14 days or 21 days depending on participant responses. The intervention known as ‘Spaced Education’ (SE) is built around clinicians answering small numbers of case-based multiple choice questions that are emailed to them over a number of days. These questions are repeated using an evidence-based adaptive algorithm which personalizes the spacing and content of a course to the demonstrated knowledge level of each learner. The program will be completed when each GP answers each question correctly twice, and is expected to take 6 to 8 weeks. Following completion of the SED program, all GPs will view a further six video vignettes (2-4 minutes each), with scenarios similar to those presented in phase 1 of the study, featuring an actor portraying a patient with diabetes presenting to a GP. GPs will be able to access and complete vignette scenarios in their own time, and will have approximately 3 months to complete the final six scenarios. Participants are again invited to answer questions on whether they would prescribe a drug, investigate or write a referral for the patients in the videos. Real Patients - GPs will again be asked for de-identified data on the same 30 type 2 diabetic patients under their care, at 6 months and 9 months after randomisation to measure the change in GP management of type 2 diabetes from baseline to post-SED intervention. It is envisaged that phase 2 will take 9 months.