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1. Effective primary care for people with non-insulin dependent diabetes mellitus : towards earlier detection and better delivery of care in general practice

Author

Griffin, Simon James

Subjects
362.1, Health services & community care services
Abstract

This thesis is concerned with improving the detection of, and delivery of care to, people with non-insulin dependent diabetes (NIDDM). Over one year, 41 general practices in Southern England returned data on all newly diagnosed patients. These data were compared with information from the Health Survey for England 1994, then pooled with half the data from the population cross-sectional study, including glucose tolerance testing, to develop a model predicting undiagnosed NIDDM. The model was tested in the remaining half of the population cross-section. Finally, standard systematic review methods with investigation of between-trial heterogeneity, including meta-regression, were used to identify and evaluate trials comparing general practice and hospital care for NIDDM. The incidence of NIDDM was 1.15/1000 person years. 522 were diagnosed with NIDDM, 84% in general practice. 34% presented with classical symptoms of hyperglycaemia. Mean age at diagnosis was 63 years, men were diagnosis more often and at a younger age than women. New cases were significantly more obese and more likely to be prescribed cardiovascular medication than age-sex matched population controls. A risk score including these and other routinely available data identified NIDDM with 77% sensitivity and 72% specificity. Mortality, glycaemic control and follow up for diagnosed patients in general practice were dependent on the provision of intensive support including a central, computerised system to prompt patients and practitioners to undertake aspects of care. The systematic review of five trials indicates that once diagnosed, patients can receive standards of care in general practice as good as, or better than, hospital outpatient care, provided that suitable organisation is in place.

Published
1999

2. A randomised controlled trial of three very brief interventions for physical activity in primary care

Author

Simon J. Griffin, Richard A Parker, Stephen Sutton, Joana C. Vasconcelos, A T Prevost, Sally Pears, Wendy Hardeman, Ann Louise Kinmonth, Maaike Bijker, Katie L. Morton, Kate Westgate, Edward C. F. Wilson, Soren Brage, Hardeman, Wendy [0000-0002-6498-9407], Apollo - University of Cambridge Repository, Westgate, Kathryn Louise [0000-0002-0283-3562], Brage, Soren [0000-0002-1265-7355], Wilson, Edward Charles [0000-0002-8369-1577], and Griffin, Simon James [0000-0002-2157-4797]

Subjects
Adult, Male, VBI Programme Team, medicine.medical_specialty, Health Behavior, Psychological intervention, Physical activity, Primary care, Public Health And Health Services, Health check, law.invention, 03 medical and health sciences, 0302 clinical medicine, Randomized controlled trial, law, Environmental health, Behaviour change techniques, Epidemiology, medicine, Humans, Very brief interventions, 030212 general & internal medicine, Exercise, Public, Environmental & Occupational Health, Motivation, Public health, Science & Technology, Primary Health Care, business.industry, lcsh:Public aspects of medicine, Public Health, Environmental and Occupational Health, lcsh:RA1-1270, 030229 sport sciences, Middle Aged, Actigraphy, Treatment Outcome, Pedometer, Physical therapy, Feasibility Studies, Health promotion, Female, Biostatistics, business, Life Sciences & Biomedicine, Research Article
Abstract

$\textbf{Background}$ Very brief interventions (VBIs) for physical activity are promising, but there is uncertainty about their potential effectiveness and cost. We assessed potential efficacy, feasibility, acceptability, and cost of three VBIs in primary care, in order to select the most promising intervention for evaluation in a subsequent large-scale RCT. $\textbf{Methods}$ Three hundred and ninety four adults aged 40–74 years were randomised to a Motivational ($\textit{n}$ = 83), Pedometer ($\textit{n}$ = 74), or Combined ($\textit{n}$ = 80) intervention, delivered immediately after a preventative health check in primary care, or control (Health Check only; $\textit{n}$ = 157). Potential efficacy was measured as the probability of a positive difference between an intervention arm and the control arm in mean physical activity, measured by accelerometry at 4 weeks. $\textbf{Results}$ For the primary outcome the estimated effect sizes (95 % CI) relative to the Control arm for the Motivational, Pedometer and Combined arms were respectively: +20.3 (−45.0, +85.7), +23.5 (−51.3, +98.3), and −3.1 (−69.3, +63.1) counts per minute. There was a73% probability of a positive effect on physical activity for each of the Motivational and Pedometer VBIs relative to control, but only 46 % for the Combined VBI. Only the Pedometer VBI was deliverable within 5 min. All VBIs were acceptable and low cost. $\textbf{Conclusions}$ Based on the four criteria, the Pedometer VBI was selected for evaluation in a large-scale trial. $\textbf{Trial registration}$ Current Controlled Trials ISRCTN02863077. Retrospectively registered 05/10/2012., This paper presents independent research funded by the National Institute for Health Research (NIHR) under its Programme Grants for Applied Research Programme (Grant Reference Number RP-PG-0608-10079). ATP and JV were supported by the NIHR Biomedical Research Centre at Guy’s and St Thomas’ NHS Foundation Trust and King’s College London. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health. The funder had no role in study design, data collection, data analysis, data interpretation, the writing of the manuscript, and decision to submit the manuscript for publication., This is the final version of the article. It first appeared from BioMed Central via https://doi.org/10.1186/s12889-016-3684-7

Published
2016

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