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Table 8 Summary of key findings

From: Referral of patients to diabetes prevention programmes from community campaigns and general practices: mixed-method evaluation using the RE-AIM framework and Normalisation Process Theory

RE-AIM Dimension Key Findings
Reach • The community campaign completed diabetes risk scores with 1162 people, and blood tests with 746 people, of which 71 were diagnosed with NDH and 66 (6%) were referred to a local DPP. The conversion rate was disappointing, suggesting that the community campaign was not particularly effective. • There were 883 referrals to the DPP from primary care A nurse facilitator undertook electronic searches and/or clinics in 16 practices and thisresulted in the referral of referred 774 (88%) patients to the DPP. The remaining 109 (12%) were referred from the 30 practices without support from the nurse facilitator. This suggests that the addition of the nurse facilitator was effective in producing more referrals. • Within thecommunity referral route, of the completed diabetes risk scores, 46% were with people over 70, 65% were for women, 7% were for someone from an ethnic minority and rates of completion were higher in the least deprived wards and those with lower rates of diabetes. This suggests that further targeting to high risk groups would be beneficial. • The community campaign led to 8 people starting the telephone DPP (22% of those referred). The facilitated GP route (16 practices) led to 288 people starting the telephone DPP (45% of those referred). The GPs without extra facilitation (30 practices) led to 3 people starting the telephone DPP (100% of those referred).
Effectiveness Not assessed in this study.
Adoption • Adoption of the intervention itself was strongly supported by the professionals involved in delivery, with consensus around the need for additional resource to support identification in primary care, and the need for community-focused organisations to expand identification beyond clinical settings. • However, in the community service, a lack of buy-in to the need for collaborative working hindered inter-agency collaboration in the early stages of delivery.
Implementation • The facilitated GP route was comparatively easier to implement, with the role of the nurse facilitator well understood and integrated into existing processes. The community services, due to lack of consensus around the value and processes of collaborative working, did not work in the integrated way intended. Resulting pressures impacted Reach, as there was a lack of fidelity to the intended focus on high-risk patient populations. • Adaptations over time had the potential to impact both routes, both positively and negatively. In the community services, collaboration was enhanced through deliberate efforts to improve inter-agency working. In the GP route, changes to staff involved may undermine trust in the process.
Maintenance Once people had started in a DPP programme, the retention rates were fairly high, with 73% of people completing the telephone DPP and 84% completing the exercise DPP. Retention rates were lower among the community referrals (50% in the telephone DPP and 75% in the exercise DPP), but this is based on small numbers of community referrals, so the result must be treated cautiously.