RT Journal Article
SR Electronic
T1 Intervention to Improve Psychosocial Care for People with Type 2 Diabetes
JF The Journal of the American Board of Family
                Medicine
JO J Am Board Fam Med
FD American Board of Family Medicine
SP 253
OP 274
DO 10.3122/jabfm.2024.240265R1
VO 38
IS 2
A1 Cohen, Deborah J.
A1 Sweeney, Shannon M.
A1 Springer, Rachel
A1 Balasubramanian, Bijal A.
A1 Michaels, LeAnn
A1 Marino, Miguel
A1 Hessler, Danielle
A1 Baron, Andrea
A1 Nesse, Johanna
YR 2025
UL http://www.jabfm.org/content/38/2/253.abstract
AB Background: This proof-of-concept study tested the feasibility and acceptability of INTEGRATE-D, an implementation support intervention for primary care clinics to improve the psychosocial care of patients with type 2 diabetes.Methods: Cluster randomized controlled pragmatic trial, with a parallel, convergent mixed methods design. Two Intervention Clinics (ICs) were offered tailored training on American Diabetes Association (ADA)-recommended psychosocial care and facilitation to identify and support clinical change. Two Control Clinics (CCs) received no intervention. Primary outcomes: intervention acceptability, appropriateness and feasibility. Secondary outcomes: process-of-care metrics (eg, depression screening, diabetes management) and clinical outcomes measures (PHQ-9 and A1C). Qualitative data were collected to assess implementation and experience with the intervention.Results: ICs were offered training and received 15-months of facilitation. To accommodate COVID-19-related safety restrictions, the intervention was changed to be delivered virtually (eg, remote facilitation and training sessions). Despite an adapted delivery and COVID-19 and staffing stressors, clinics exposed to INTEGRATE-D found it to be acceptable, well-aligned with clinics’ needs, and feasible. Qualitative data suggest COVID-19 stressors tempered feasibility. The effect of INTEGRATE-D on process and clinical outcome measures were mixed. Several factors, including differences in ICs and CCs not addressed in randomization and delivery of a less intensive intervention due to the pandemic, may help explain these results.Conclusions: Given the growing number of people with type 2 diabetes and the importance of psychosocial care for these patients, INTEGRATE-D warrants further pilot-testing with a larger sample of clinics and patients, and under conditions where in-person facilitation and expanded training is possible.