The finer details

This research is about integrating a health care delivery approach into primary care that features whole food dietary advice based on carbohydrate-reduction, delivered in a manner that is culturally responsive, inclusive, supportive and sustaining using a health coach approach and other levels of support.

The role of each Health practitioner

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• The role of the doctor is to identify relevant patients and refer to the health coach or other members of the multidisciplinary team be it practice nurses, or dietitians (or a combination). The doctor can be involved with as little or as much of the dietary advice provision as they choose. The doctor will at the very least understand the key concepts of the diet, be supportive of its application, and importantly, understand how to manage medication de-prescribing (especially blood pressure and diabetes medications) as the diet is applied.

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• The role of the health coach is to provide behaviour change coaching with the patient to help support them to make healthy diet and lifestyle choices, to keep them motivated and on-track with forming and maintaining healthy habits. This includes choices relating to diet, exercise, stress, sleep, and other lifestyle aspects as relevant. The health coach will be well versed in knowledge of suitable recipes, recipe manipulation for carbohydrate-reduction, shopping, budgeting, cooking ideas etc... and will be communicating this information in a behaviour-change framework.

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•  The role of the dietitian is to provide dietary support for the health coach and patient as needed ie., diet plans and advice, clinical considerations i.e., allergies, nutrient-optimising strategies, managing other conditions.

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• “The Health Coach Approach” is a client-centered method used by health coaches to empower individuals to achieve their health and wellness goals. This approach is characterised by several key elements: This approach (health coaching) can be delivered by doctors, dietitians, practice nurses, supporting community health workers and is not restricted to the health coaches themselves. The role of the practice nurse can be multifaceted; they can be involved with patient education including lifestyle management and counselling, clinical care such as medication management, and monitoring and management of complications, as well as providing support for this research project by contacting / liaising with patients.

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The programme / research itself

 

• Implementation: Each practice is unique in terms of its needs, resources, capabilities, structure, funding, access to health coaches and patient demographics. As such, each practice might decide on a different way of implementation, which will depend on these factors. We envisage this model to be embedded in usual practice rather than implementing a new generic programme applied by others/contractors. We will provide plenty of support as to how best to do this before it begins.

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• Training will be provided to those clinics / entities that require it. Once the health care team is trained and ready to proceed, the model will be implemented in each clinic. There isn’t a set number of patients that is required.

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• Resources: We have provided a range of resources which will help health professionals and patients /community. These resources will be used / referred to alongside the training and you may use any of them in your usual practice. (#WholeNZ resource hub)

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• Patient inclusion: The criteria for inclusion is adults over 20 years of age with a diagnosis of pre-diabetes or T2D (new or existing).

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•  Patient recruitment: Designated clinic personnel (depending on the set-up of each clinic) will contact patients and invite them for an initial consultation with the doctor, who will then refer to the health coach or relevant educator. There is not a set number of patients that need to be recruited per se, but rather this will include the patients in the practice that have pre-diabetes or T2D (existing or new diagnoses) that are interested in this management approach.

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• Funding: Some PHOs have funding support for extended consultations. For practices that expect Income for seeing patients, discussions with the PHO about potential funding sources for eligible patients will be needed. There is no funding per se allocated to the practices or patients from the research fund, but rather training and full support will be provided, including our #WholeNZ resource hub, where patients and health professional resources can be accessed. Koha will be provided for qualitative data collection interviews (health professionals) and focus groups (patients) during the evaluation period.

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• Frequency of contact points: After their initial appointment with the doctor, patients will be referred to the health coach/relevant educator and supporting initiatives; ongoing follow-up is determined by the health coach or other relevant personnel. Patients visit the doctor / nurse again as needed - for medication reduction or general check-up as they currently would.

 

• Number of doctors or health professionals involved: There is no set number required. We are interested in working with as many doctors and health professionals as are interested in working using this management approach.

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•  Duration: The Reverse Type 2 Diabetes model of care will be delivered for 12 months (for the purpose of the research project) and subject to success, we hope that it will continue thereafter as the preferred model of care, which can then be extended to patients with other chronic diseases where relevant.

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Outcome measures (data to be collected)

 

• The following data will be collected over this 12 month period:

o Quantitative data – overall, we are interested in finding out how the patients have fared using
this healthcare approach, and will include the following:
- Assessment of patient engagement (i.e., assessment of attendance (number of sessions) at
health coach support sessions and supporting initiatives.
- Patients’ change in metabolic markers: HbA1c; weight, waist circumference, lipids, renal, liver
function, blood pressure. These markers will all be measured at the start and after 12 months;
some markers will likely be measured in the interim, especially HbA1C (every 3 months at
least).
- Patient medication change (type / dosage...)
- Other: adverse effects, anything else relevant

 

• What this means is good documentation and record keeping, as per usual care. When it comes to data analysis, relevant data will be extracted from the datawarehouse at three-month intervals and provided to the researchers. NOTE: all patient identities will be removed, thereby assuring patient privacy and anonymity.

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• Alongside this, a retrospective patient record analysis (patients with pre-diabetes and T2D) from each medical centre on 12 months’ worth of prior data will be accessed. Patient outcomes will be compared over these two, 12-month periods.

o Qualitative data – we are interested in how this process has played out from several perspectives over the course of the 12 months

- Researchers will conduct interviews with health care professionals (doctors, health coaches,
other health care team members) to assess their experience with this model of care (i.e.,
barriers and enablers to the adoption, adaptation, and sustained use of this model moving
forward).

- Researchers will conduct focus groups with a sample of patients from each clinic at some point
during the 12 month process. Patients will be asked about their experiences of participating in
the Reverse T2D model.