Advanced primary care models emphasize patient-centered care, including self-management support (SMS). Connection to Health (CTH) is a comprehensive, evidence-based SMS program that enhances interactions between primary care clinicians and patients. Uptake and maintenance of programs such as CTH in primary care have been limited by the inability of practices to adapt and implement program components into their culture, patient flow, and work processes. Thirty-six primary care practices participated in a three-arm, cluster-randomized trial to determine the incremental benefit of brief, targeted practice facilitation on the implementation of CTH. Practices receiving the CTH program, compared to those receiving only standard SMS education, showed significantly greater improvement in SMS activities (e.g., goal setting, action planning, patient follow-up, behavioral health discussions), as assessed by chart audit (p<0.022). Yet, there was variable practice-level use of the CTH tools during the 9-month intervention. Practices receiving practice facilitation used CTH more with patients with higher hemoglobin A1c levels and more comorbidity. Qualitative analysis of interviews and field notes point to barriers impeding uptake and maintenance of SMS: lack of visible champions, lack of shared vision, low interest in CTH/SMS, emergent higher priorities, clinician/staff turnover, and perceived redundancy of CTH. Facilitating factors included alignment with system priorities, role and time dedicated to SMS delivery, functional practice teams, and adapting CTH to fit with existing workflows. The overall effect of introducing the SMS program and facilitation support suggests primary care practices can improve their delivery of SMS to patients with T2DM with a brief targeted intervention. However, broadly implementing and sustaining SMS programs in primary care will require attention to overcoming barriers and building on individual practice’s facilitating factors.

Disclosure

D. Fernald: None. D.M. Hessler: Consultant; Self; Eli Lilly and Company. V. Bowyer: None. B. Jortberg: None. R. Wearner: None. L. Fisher: Consultant; Self; Abbott, Eli Lilly and Company. P. Dickinson: None.

Funding

National Institute of Diabetes and Digestive and Kidney Diseases (1R18DK096387-01)

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