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Table 4 Implementation fidelity of the EMPOWER-PAR intervention

From: Effectiveness of the EMPOWER-PAR Intervention in Improving Clinical Outcomes of Type 2 Diabetes Mellitus in Primary Care: A Pragmatic Cluster Randomised Controlled Trial

Intervention clinics Obligatory EMPOWER PAR intervention Optional EMPOWER PAR intervention
Creating/Strengthening a CDM team & CDM delivery system Utilising T2DM CPG Utilising the Global CV risks self-management booklet Utilising clinical information system and conducting clinical audits Utilising community resources
Clinic 1 Pre-existing system Pre-existing dedicated chronic disease clinic for T2DM & HPT (appointment system, flow of patients, defaulter tracing etc.)
1 medical officer, 2 nurses, 1 pharmacist and 2 attendants were running this clinic.
CPG was available in the FMS room. Patients carried the ‘mini green book’. The clinic utilised the ‘green book’ for medical record keeping.
Participated in the National Diabetes Registry program –a national audit for T2DM.
No community involvement.
Changes made & implementation fidelity Five existing members were trained in the CDM Workshops, led by the FMS.
The CDM Team and the delivery system were further strengthened.
CPG QR was made available in hard and soft copies in each consultation room and was utilised by team members for decision making. The clinic fully utilised the Global CV Risk Self Management Booklet. The book became popular amongst patients and was coined as the “Power” book. Continued with the pre-existing system. Attempts were made but there was no formalised community involvement.
Clinic 2 Pre-existing system No pre-existing dedicated chronic disease clinic.
Acute and chronic cases were seen in the integrated general outpatient clinic.
A medical officer and a nurse were in-charge of T2DM patients.
CPG was available in the FMS room. Patients carried the ‘mini green book’. The clinic utilised the ‘green book’ for medical record keeping.
Participated in the National Diabetes Registry program – a national audit for T2DM.
The clinic had an advisory panel consisted of community members.
Participated in the Non-Communicable Disease-1Malaysia (NCD-1 M) programme.
Changes made & implementation fidelity Five CDM Team members identified and trained (medical officer, nurse, medical assistant, dietician, and pharmacist, led by the FMS).
Two members left at 6-month post intervention, and two new members retrained.
The clinic created a new CDM delivery system (appointment system, flow of patients, defaulter tracing etc.)
CPG QR was made available in each consultation room and was utilised by team members for decision making during consultation. The clinic distributed and utilised the Global CV Risk Self Management Booklet to support patients’ self-management during consultation. Continued with the pre-existing system. Continued with the pre-existing system.
Clinic 3 Pre-existing system No pre-existing dedicated chronic disease clinic. Acute and chronic cases were seen in the integrated general outpatient clinic.
A medical officer and a nurse were in-charge of T2DM patients.
CPG was available in each consultation room; however, there was no regular discussion among team member regarding case management according to CPG. Patients carried the ‘mini green book’. The clinic utilised the ‘green book’ for medical record keeping.
Participated in the National Diabetes Registry program – a national audit for T2DM.
The clinic had an advisory panel consisted of community members.
Participated in the NCD-1 M programme.
Changes made & implementation fidelity Five CDM Team members identified and trained (medical officer, nurse, medical assistant, dietician, and pharmacist, led by the FMS).
The clinic created a new CDM delivery system (appointment system, flow of patients, defaulter tracing etc.)
CPG QR was made available in hard and soft copies in each consultation room and was utilised by team members for decision making.
Discussion on case management according to the CPG was done 2-monthly with the FMS.
The clinic distributed and utilised the Global CV Risk Self Management Booklet to support patients’ self-management during consultation.
Scheduled patient education series were conducted, which included diabetes conversation maps and cooking demonstration.
Continued with the pre-existing system. Continued with the pre-existing system.
Clinic 4 Pre-existing system Pre-existing dedicated chronic disease clinic ran by a team of 7 health care providers. CPG was available in each consultation room; with online information on management of T2DM. Patients carried the ‘mini green book’. The clinic utilised the ‘green book’ for medical record keeping. Participated in the National Diabetes Registry program – a national audit for T2DM. None.
Changes made & implementation fidelity Five existing members were trained in the CDM Workshops, led by the FMS.
The CDM Team and the delivery system were further strengthened through team building and cooperation.
CPG QR utilisation was further strengthened in decision-making process during consultation. The clinic distributed and utilised the Global CV Risk Self Management Booklet to support patients’ self-management during consultation.
Formation of structured diabetes education program and Medication and Therapeutic Adherence Counselling (MTAC).
Continued with the pre-existing system. Not developed.
Clinic 5 Pre-existing system No pre-existing dedicated chronic disease clinic. Acute and chronic cases were seen in the integrated general outpatient clinic.
One staff nurse handled T2DM cases.
CPG was not available at the nurses’ counter or in the doctors’ consultation rooms Patients carried the ‘mini green book’. The clinic has its own diabetes registry, prepared and updated by the AMO regularly. AMO was familiar with SPSS and utilised it to analyse patients’ data. This is a new clinic in a new modern township, consisting of young working families. There was no engagement with the community resources.
Changes made & implementation fidelity Five CDM Team members were identified and trained. FMS was transferred out; a staff nurse took over the leadership of the team. Two medical officers were assigned to see patients with chronic diseases in the morning every day. CPG QR was made available in the consultation rooms and the nurses’ counter, and was utilised by team members for decision making. The clinic distributed and utilised the Global CV Risk Self Management Booklet to support patients’ self-management during consultation.
Some patients found it useful, but some forgot to bring along during follow-up appointments.
The clinic utilised their registry for clinical audit and tracing defaulters. Not developed.