Implementation of the DP-TRANSFERS project in Catalonia: A translational method to improve diabetes screening and prevention in primary care

PLoS One. 2018 Mar 15;13(3):e0194005. doi: 10.1371/journal.pone.0194005. eCollection 2018.

Abstract

Background: The DE-PLAN-CAT project (Diabetes in Europe-Prevention using lifestyle, physical activity and nutritional intervention-Catalonia) has shown that an intensive lifestyle intervention is feasible in the primary care setting and substantially reduces the incidence of diabetes among high-risk Mediterranean participants. The DP-TRANSFERS project (Diabetes Prevention-Transferring findings from European research to society) is a large-scale national programme aimed at implementing this intervention in primary care centres whenever feasible.

Methods: A multidisciplinary committee first evaluated the programme in health professionals and then participants without diabetes aged 45-75 years identified as being at risk of developing diabetes: FINDRISC (Finnish Diabetes Risk Score)>11 and/or pre-diabetes diagnosis. Implementation was supported by a 4-channel transfer approach (institutional relationships, facilitator workshops, collaborative groupware, programme website) and built upon a 3-step (screening, intervention, follow-up) real-life strategy. The 2-year lifestyle intervention included a 9-hour basic module (6 sessions) and a subsequent 15-hour continuity module (10 sessions) delivered by trained primary healthcare professionals. A 3-level (centre, professionals and participants) descriptive analysis was conducted using cluster sampling to assess results and barriers identified one year after implementation.

Results: The programme was started in June-2016 and evaluated in July-2017. In all, 103 centres covering all the primary care services for 1.4 million inhabitants (27.9% of all centres in Catalonia) and 506 professionals agreed to develop the programme. At the end of the first year, 83 centres (80.6%) remained active and 305 professionals (60.3%) maintained regular web-based activities. Implementation was not feasible in 20 centres (19.4%), and 5 main barriers were prioritized: lack of healthcare manager commitment; discontinuity of the initial effort; substantial increase in staff workload; shift in professional status and lack of acceptance. Overall, 1819 people were screened and 1458 (80.1%) followed the lifestyle intervention, with 1190 (81.6% or 65.4% of those screened) participating in the basic module and 912 in the continuity module (62.5% or 50.1%, respectively).

Conclusions: A large-scale lifestyle intervention in primary care can be properly implemented within a reasonably short time using existing public healthcare resources. Regrettably, one fifth of the centres and more than one third of the professionals showed substantial resistance to performing these additional activities.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Diabetes Mellitus, Type 2 / diagnosis*
  • Diabetes Mellitus, Type 2 / epidemiology
  • Diabetes Mellitus, Type 2 / prevention & control*
  • Europe / epidemiology
  • Exercise / physiology
  • Female
  • Health Personnel
  • Humans
  • Incidence
  • Life Style
  • Male
  • Mass Screening / methods
  • Middle Aged
  • Primary Health Care / methods*
  • Risk Reduction Behavior

Grant support

(1). Institute of Health Carlos III, [www.isciii.es], Spanish Ministry of Health and the European Regional Development Fund (ERDF/FEDER): grant agreements PI14/00122, FIS PI05-033, PS09-001112 (BCP), and PI14/00124 (FBT) (2). La Marató de TV3 Foundation [www.ccma.cat/tv3/marato/] (2015 grant agreement 73-201609.10), (3). Spanish Diabetes Society [www.sediabetes.org] (2015 Guido Ruffino grant for research projects on therapeutic education) (BCP) and (4). Department of Health, Generalitat de Catalunya and the PERIS (Pla Estratègic de Recerca i Innovació en Salut) 2016-2020, [salutweb.gencat.cat/ca/ambits_tematics/linies…/recerca], grant agreements SLT002/16/00045 (BC), SLT002/16/00154 (FB) and SLT002/16/00093 (JJC). (5). Directorate-General for Health and Consumers (2004310) (BCP) The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.