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

Overview of attention for article published in BMC Family Practice, November 2016
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Title
Effectiveness of the EMPOWER-PAR Intervention in Improving Clinical Outcomes of Type 2 Diabetes Mellitus in Primary Care: A Pragmatic Cluster Randomised Controlled Trial
Published in
BMC Family Practice, November 2016
DOI 10.1186/s12875-016-0557-1
Pubmed ID
Authors

Anis Safura Ramli, Sharmini Selvarajah, Maryam Hannah Daud, Jamaiyah Haniff, Suraya Abdul-Razak, Tg Mohd Ikhwan Tg-Abu-Bakar-Sidik, Mohamad Adam Bujang, Boon How Chew, Thuhairah Rahman, Seng Fah Tong, Asrul Akmal Shafie, Verna K. M. Lee, Kien Keat Ng, Farnaza Ariffin, Hasidah Abdul-Hamid, Md Yasin Mazapuspavina, Nafiza Mat-Nasir, Chun W. Chan, Abdul Rahman Yong-Rafidah, Mastura Ismail, Sharmila Lakshmanan, Wilson H. H. Low

Abstract

The chronic care model was proven effective in improving clinical outcomes of diabetes in developed countries. However, evidence in developing countries is scarce. The objective of this study was to evaluate the effectiveness of EMPOWER-PAR intervention (based on the chronic care model) in improving clinical outcomes for type 2 diabetes mellitus using readily available resources in the Malaysian public primary care setting. This was a pragmatic, cluster-randomised, parallel, matched pair, controlled trial using participatory action research approach, conducted in 10 public primary care clinics in Malaysia. Five clinics were randomly selected to provide the EMPOWER-PAR intervention for 1 year and another five clinics continued with usual care. Patients who fulfilled the criteria were recruited over a 2-week period by each clinic. The obligatory intervention components were designed based on four elements of the chronic care model i.e. healthcare organisation, delivery system design, self-management support and decision support. The primary outcome was the change in the proportion of patients achieving HbA1c < 6.5%. Secondary outcomes were the change in proportion of patients achieving targets for blood pressure, lipid profile, body mass index and waist circumference. Intention to treat analysis was performed for all outcome measures. A generalised estimating equation method was used to account for baseline differences and clustering effect. A total of 888 type 2 diabetes mellitus patients were recruited at baseline (intervention: 471 vs. 417). At 1-year, 96.6 and 97.8% of patients in the intervention and control groups completed the study, respectively. The baseline demographic and clinical characteristics of both groups were comparable. The change in the proportion of patients achieving HbA1c target was significantly higher in the intervention compared to the control group (intervention: 3.0% vs. -4.1%, P < 0.002). Patients who received the EMPOWER-PAR intervention were twice more likely to achieve HbA1c target compared to those in the control group (adjusted OR 2.16, 95% CI 1.34-3.50, P < 0.002). However, there was no significant improvement found in the secondary outcomes. This study demonstrates that the EMPOWER-PAR intervention was effective in improving the primary outcome for type 2 diabetes in the Malaysian public primary care setting. Registered with: ClinicalTrials.gov.: NCT01545401 . Date of registration: 1st March 2012.

Twitter Demographics

The data shown below were collected from the profile of 1 tweeter who shared this research output. Click here to find out more about how the information was compiled.

Mendeley readers

The data shown below were compiled from readership statistics for 92 Mendeley readers of this research output. Click here to see the associated Mendeley record.

Geographical breakdown

Country Count As %
Unknown 92 100%

Demographic breakdown

Readers by professional status Count As %
Student > Ph. D. Student 19 21%
Student > Master 16 17%
Researcher 15 16%
Lecturer > Senior Lecturer 7 8%
Professor > Associate Professor 5 5%
Other 22 24%
Unknown 8 9%
Readers by discipline Count As %
Medicine and Dentistry 40 43%
Nursing and Health Professions 14 15%
Social Sciences 6 7%
Pharmacology, Toxicology and Pharmaceutical Science 6 7%
Psychology 5 5%
Other 8 9%
Unknown 13 14%

Attention Score in Context

This research output has an Altmetric Attention Score of 2. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 12 September 2019.
All research outputs
#8,737,983
of 14,480,135 outputs
Outputs from BMC Family Practice
#971
of 1,472 outputs
Outputs of similar age
#143,406
of 264,959 outputs
Outputs of similar age from BMC Family Practice
#1
of 2 outputs
Altmetric has tracked 14,480,135 research outputs across all sources so far. This one is in the 37th percentile – i.e., 37% of other outputs scored the same or lower than it.
So far Altmetric has tracked 1,472 research outputs from this source. They typically receive a little more attention than average, with a mean Attention Score of 6.6. This one is in the 29th percentile – i.e., 29% of its peers scored the same or lower than it.
Older research outputs will score higher simply because they've had more time to accumulate mentions. To account for age we can compare this Altmetric Attention Score to the 264,959 tracked outputs that were published within six weeks on either side of this one in any source. This one is in the 42nd percentile – i.e., 42% of its contemporaries scored the same or lower than it.
We're also able to compare this research output to 2 others from the same source and published within six weeks on either side of this one. This one has scored higher than all of them