Evidence mapPaperPMID 32051304Full record

Trial reportBMJ open2020

Supporting care for suboptimally controlled type 2 diabetes mellitus in general practice with a clinical decision support system: a mixed methods pilot cluster randomised trial.

Mark E Murphy, Jenny McSharry, Molly Byrne, Fiona Boland, Derek Corrigan, Paddy Gillespie, Tom Fahey, Susan M Smith

Open access · goldAbstract readMulticenter StudyRandomized Controlled Trial
In one paragraph

Trial report in BMJ open, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
9citing papers in PubMed, 1 pooled it
1.8field-weighted citation impact, top 14% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

9 citing papers in PubMed, 1 synthesis or guideline pooled it, 17 citations in OpenAlex.

  1. Pooled it
  2. Trial
  3. Article
  4. Article
  5. Article
  6. Article
  7. Article
  8. Review
  9. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors at 3 institutions in 2 countries.

Mark E MurphyDepartment of General Practice, HRB Centre for Primary Care Research, Royal College of Surgeons, Dublin, Ireland markmurphy@rcsi.ie.ORCID 0000-0002-4240-5327
Jenny McSharryHealth Behaviour Change Research Group, School of Psycology, NUI Galway, Galway, Ireland.
Molly ByrneHealth Behaviour Change Research Group, School of Psycology, NUI Galway, Galway, Ireland.
Fiona BolandDepartment of General Practice, HRB Centre for Primary Care Research, Royal College of Surgeons, Dublin, Ireland.ORCID 0000-0003-3228-0046
Derek CorriganDepartment of General Practice, HRB Centre for Primary Care Research, Royal College of Surgeons, Dublin, Ireland.
Paddy GillespieSchool of Business and Economics, National University of Ireland, Galway, Ireland.
Tom FaheyDepartment of General Practice, HRB Centre for Primary Care Research, Royal College of Surgeons, Dublin, Ireland.ORCID 0000-0002-5896-5783
Susan M SmithDepartment of General Practice, HRB Centre for Primary Care Research, Royal College of Surgeons, Dublin, Ireland.
Royal College of Surgeons in Ireland · IEOllscoil na Gaillimhe – University of Galway · IENational University of Ireland · IE

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectivesWe developed a complex intervention called DECIDE (Computerise

designA pilot cluster randomised controlled trial.

settingConducted in 14 practices in Irish General Practice.

participantsThe DECIDE intervention was targeted at GPs. They applied DECIDE to patients with suboptimally controlled T2DM, defined as a glycated haemoglobin (HbA1c) ≥70 mmol/mol and/or blood pressure ≥150/95 mmHg.

interventionThe intervention incorporated training and a web-based clinical decision support system which supported; (i) medication intensification actions; and (ii) non-pharmacological actions to support care. Control practices delivered usual care. PRIMARY AND SECONDARY OUTCOME MEASURES: Feasibility and acceptability was determined using thematic analysis of semi-structured interviews with GPs, combined with data from the DECIDE website. Clinical outcomes included HbA1c, medication intensification, blood pressure and lipids.

resultsWe recruited 14 practices and 134 patients. At 4-month follow-up, all practices and 114 patients were followed up. GPs reported finding decision support helpful navigating increasingly complex medication algorithms. However, the majority of GPs believed that the target patient group had poor engagement with GP and hospital services for a range of reasons. At follow-up, there was no difference in glycaemic control (-3.6 mmol/mol (95% CI -11.2 to 4.0)) between intervention and control groups or in secondary outcomes including, blood pressure, total cholesterol, medication intensification or utilisation of services. Continuation criteria supported proceeding to a definitive randomised trial with some modifications.

conclusionThe DECIDE study was feasible and acceptable to GPs but wider impacts on glycaemic and blood pressure control need to be considered for this patient population going forward. TRIAL REGISTRATION NUMBER: ISRCTN69498919.

Indexed as

Decision Support Systems, ClinicalCluster AnalysisDiabetes Mellitus, Type 2Feasibility StudiesFemaleFollow-Up StudiesGeneral PracticeHumansMaleMiddle AgedPatient Acceptance of Health CarePilot Projectsdiabetes & endocrinologyepidemiologyprimary carequality in health care

Identifiers

PMID32051304
PMCPMC7045235
OpenAlexW3006098839

What Socratic holds

Textmetadata
LicenceCC BY-NC
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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.