188-LB: Type 2 Diabetes Is Genetically Correlated with Multiple Long-Term Conditions but These Correlations Are Only Partly Explained by BMI

Adherence therapy has been shown to be an effective adjunct treatment in long-term conditions including hypertension. The purpose of this study is to review and critically appraise evidence on the effectiveness of adherence therapy as an intervention in adults with type 2 diabetes. A systematic search of clinical trials published between 2005 and January 2020 in databases was undertaken in October 2018 and updated in August 2020. Inclusion criteria were any clinical trials where the population under investigation was adults with type 2 diabetes and the experimental intervention was adherence therapy. Version 2 of the Cochrane risk of bias was used to determine the quality of the included studies. No studies met our inclusion criteria. However, four studies that we excluded at full text screening tested some of the components (e.g., problem solving) of adherence therapy. As is recommended when reporting empty reviews, those studies were synthesized to determine if useful information can be extracted. That no trials of adherence therapy have been reported in type 2 diabetes establishes a potentially important gap in knowledge. This review was registered in PROSPERO (registration number: CRD42019115216) after the initial searches were completed.

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Could social prescribing contribute to type 2 diabetes prevention in people at high risk? Protocol for a realist, multilevel, mixed methods review and evaluation

BMJ Open ◽

10.1136/bmjopen-2020-042303 ◽

2021 ◽

Vol 11 (4) ◽

pp. e042303

Author(s):

Sara Calderón Larrañaga ◽

Megan Clinch ◽

Trisha Greenhalgh ◽

Sarah Finer

Keyword(s):

Type 2 Diabetes ◽

National Health Service ◽

High Risk ◽

Health Service ◽

National Health ◽

Stakeholder Group ◽

Long Term Conditions ◽

Social Prescribing

IntroductionSocial prescribing is an innovation being widely adopted within the UK National Health Service policy as a way of improving the management of people with long-term conditions, such as type 2 diabetes (T2D). It generally involves linking patients in primary care with non-medical community-based interventions. Despite widespread national support, evidence for the effectiveness of social prescribing is both insufficient and contested. In this study, we will investigate whether social prescribing can contribute to T2D prevention and, if so, when, how and in what circumstances it might best be introduced.Methods and analysisWe will draw on realist evaluation to investigate the complex interpersonal, organisational, social and policy contexts in which social prescribing relevant to T2D prevention is implemented. We will set up a stakeholder group to advise us throughout the study, which will be conducted over three interconnected stages. In stage 1, we will undertake a realist review to synthesise the current evidence base for social prescribing. In stage 2, we will investigate how social prescribing relevant to people at high risk of T2D ‘works’ in a multiethnic, socioeconomically diverse community and any interactions with existing T2D prevention services using qualitative, quantitative and realist methods. In stage 3 and building on previous stages, we will synthesise a ‘transferable framework’ that will guide implementation and evaluation of social prescribing relevant to T2D prevention at scale.Ethics and disseminationNational Health Service ethics approval has been granted (reference 20/LO/0713). This project will potentially inform the adaptation of social prescribing services to better meet the needs of people at high risk of T2D in socioeconomically deprived areas. Findings may also be transferable to other long-term conditions. Dissemination will be undertaken as a continuous process, supported by the stakeholder group. Tailored outputs will target the following audiences: (1) service providers and commissioners; (2) people at high risk of T2D and community stakeholders; and (3) policy and strategic decision makers.PROSPERO registration numberCRD42020196259.

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Can process mining automatically describe care pathways of patients with long-term conditions in UK primary care? A study protocol

BMJ Open ◽

10.1136/bmjopen-2017-019947 ◽

2018 ◽

Vol 8 (12) ◽

pp. e019947 ◽

Cited By ~ 1

Author(s):

Ian Litchfield ◽

Ciaron Hoye ◽

David Shukla ◽

Ruth Backman ◽

Alice Turner ◽

...

Keyword(s):

Type 2 Diabetes ◽

Primary Care ◽

Process Mining ◽

Process Models ◽

Ageing Population ◽

Long Term Conditions ◽

Care Processes ◽

The Uk

IntroductionIn the UK, primary care is seen as the optimal context for delivering care to an ageing population with a growing number of long-term conditions. However, if it is to meet these demands effectively and efficiently, a more precise understanding of existing care processes is required to ensure their configuration is based on robust evidence. This need to understand and optimise organisational performance is not unique to healthcare, and in industries such as telecommunications or finance, a methodology known as ‘process mining’ has become an established and successful method to identify how an organisation can best deploy resources to meet the needs of its clients and customers. Here and for the first time in the UK, we will apply it to primary care settings to gain a greater understanding of how patients with two of the most common chronic conditions are managed.Methods and analysisThe study will be conducted in three phases; first, we will apply process mining algorithms to the data held on the clinical management system of four practices of varying characteristics in the West Midlands to determine how each interacts with patients with hypertension or type 2 diabetes. Second, we will use traditional process mapping exercises at each practice to manually produce maps of care processes for the selected condition. Third, with the aid of staff and patients at each practice, we will compare and contrast the process models produced by process mining with the process maps produced via manual techniques, review differences and similarities between them and the relative importance of each. The first pilot study will be on hypertension and the second for patients diagnosed with type 2 diabetes.Ethics and disseminationEthical approval has been provided by East Midlands–Leicester South Regional Ethics Committee (REC reference 18/EM/0284). Having refined the automated production of maps of care processes, we can explore pinch points and bottlenecks, process variants and unexpected behaviour, and make informed recommendations to improve the quality and efficiency of care. The results of this study will be submitted for publication in peer-reviewed journals.

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