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Implementation of collaborative goal setting for diabetes in community primary care

  • Original Research
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Translational Behavioral Medicine

Abstract

Collaborative goal setting (CGS) is a cornerstone of diabetes self-management support, but little is known about its feasibility and effectiveness during routine care. The aim of this study was to evaluate the implementation of an existing CGS intervention when integrated by primary care staff. Using a mixed-methods approach guided by the RE-AIM framework, intervention adoption, implementation, reach, and effectiveness were evaluated over 12 months. Three of four sites adopted the CGS intervention, in which 521 patients with type 2 diabetes (9–29 % of those targeted) received CGS. For those with suboptimal glycemic control (A1C ≥ 7.5 %), %A1C decreased by 1.1 for those receiving CGS (n = 204, p < 0.001) compared to 0.4 for a group who did not (n = 41, p = 0.23). Practice characteristics influenced adoption and implementation, while isolation of CGS from the remainder of clinical care likely influenced reach and effectiveness. CGS may benefit patients with diabetes, but a lack of integration by practice staff is a key barrier to overcome during implementation.

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Acknowledgments

The authors would like to thank their community-based partners, Bery Engebretsen, Barbara Ericson, Mary Venteicher, Emily Garcia, Chris Espersen, and Sachin Bagade for supporting the work described, Darren DeWalt, Brian Mittman, Edith Parker, and Gary Rosenthal for the expertise they lent to this project, Hilary Seligman and Liana Castel for reviewing the manuscript, Tyler Goss and Andrea Mulhausen-Johnson for assisting with data collection, Linda Curran for her editorial assistance, and the clinicians and staff who graciously participated.

Support for this study was provided by the Robert Wood Johnson Foundation, Nurse Faculty Scholars Program (no. 68031; A. Wallace, P.I.), and by the University of Iowa’s Institute for Clinical and Translational Science (National Center for Research Resources no. UL1RR024979).

Author information

Authors and Affiliations

  1. The University of Iowa College of Nursing, 324 CNB, 50 Newton Road, Iowa City, IA, 52242, USA

    Andrea S. Wallace PhD, RN, Yelena Perkhounkova PhD, Maria Hein MSW & Toni Tripp-Reimer PhD, RN, FAAN

  2. The University of New Mexico School of Medicine, Albuquerque, NM, 87131, USA

    Andrew L. Sussman PhD, MCRP

  3. Department of Nursing, University of Ulsan, Daehakro 93, Nam-Gu, Ulsan, 44610, South Korea

    Sophia Jihey Chung PhD, RN

Authors
  1. Andrea S. Wallace PhD, RN
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  2. Yelena Perkhounkova PhD
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  3. Andrew L. Sussman PhD, MCRP
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  4. Maria Hein MSW
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  5. Sophia Jihey Chung PhD, RN
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  6. Toni Tripp-Reimer PhD, RN, FAAN
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Corresponding author

Correspondence to Andrea S. Wallace PhD, RN.

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Conflict of interest

The authors whose names are listed have no affiliations with or involvement in any organization or entity with any financial interest in the subject matter or materials discussed in this manuscript.

Adherence to ethical principles

All procedures were conducted in accordance with the study protocol approved by the University of Iowa Institutional Review Board.

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Implications

Practice: Collaborative goal setting is unlikely to reach the majority of diabetes patients when implemented into existing clinical structures by primary care staff.

Research: Future investigations into the effectiveness of collaborative goal setting as a means of supporting the self-management efforts of patients with diabetes ought to focus on interventions that can feasibly and sustainably integrate resources outside routine primary care service delivery.

Policy: Although collaborative goal setting is a quality indicator for self-management support provided to patients with diabetes and has the potential for improving patient outcomes, it needs to be supported by intensive efforts and outside resources that go beyond what can be feasibly delivered during routine primary service delivery

ᅟ

Andrea S. Wallace is an Assistant Professor at the University of Iowa College of Nursing.

Yelena Perkhounkova is a Statistician/Biostat Manager at the University of Iowa College of Nursing.

Andrew L. Sussman is an Assistant Professor at the University of New Mexico School of Medicine.

Maria Hein is a Research Associate and Data Manager at the University of Iowa College of Nursing.

Sophia Jihey Chung is a Graduate Research Assistant at the Department of Nursing, University of Ulsan Daehakro 93, Nam-Gu, Ulsan, South Korea, 44610.

Toni Tripp-Reimer is a Professor and Senior Advisor to the Dean at the University of Iowa College of Nursing.

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Wallace, A.S., Perkhounkova, Y., Sussman, A.L. et al. Implementation of collaborative goal setting for diabetes in community primary care. Behav. Med. Pract. Policy Res. 6, 202–211 (2016). https://doi.org/10.1007/s13142-016-0389-5

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  • DOI: https://doi.org/10.1007/s13142-016-0389-5

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