{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,10]],"date-time":"2026-02-10T17:12:43Z","timestamp":1770743563392,"version":"3.49.0"},"reference-count":58,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2021,11,9]],"date-time":"2021-11-09T00:00:00Z","timestamp":1636416000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,11,9]],"date-time":"2021-11-09T00:00:00Z","timestamp":1636416000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Health Serv Res"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>Dutch standard diabetes care is generally protocol-driven. However, considering that general practices wish to tailor diabetes care to individual patients and encourage self-management, particularly in light of current COVID-19 related constraints, protocols and other barriers may hinder implementation. The impact of dispensing with protocol and implementation of self-management interventions on patient monitoring and experiences are not known. This study aims to evaluate tailoring of care by understanding experiences of well-organised practices 1) when dispensing with protocol; 2) determining the key conditions for successful implementation of self-management interventions; and furthermore exploring patients\u2019 experiences regarding dispensing with protocol and self-management interventions.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>in this mixed-methods prospective study, practices (<jats:italic>n<\/jats:italic>\u2009=\u200949) were invited to participate if they met protocol-related quality targets, and their adult patients with well-controlled type 2 diabetes were invited if they had received protocol-based diabetes care for a minimum of 1 year. For practices, study participation consisted of the opportunity to deliver protocol-free diabetes care, with selection and implementation of self-management interventions. For patients, study participation provided exposure to protocol-free diabetes care and self-management interventions.<\/jats:p>\n                <jats:p>Qualitative outcomes (practices: 5 focus groups, 2 individual interviews) included experiences of dispensing with protocol and the implementation process of self-management interventions, operationalised as implementation fidelity. Quantitative outcomes (patients: routine registry data, surveys) consisted of diabetes monitoring completeness, satisfaction, wellbeing and health status at baseline and follow-up (24\u2009months).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p><jats:list list-type=\"bullet\">\n                  <jats:list-item>\n                    <jats:p>Qualitative:\n<jats:list list-type=\"bullet\">\n                      <jats:list-item>\n                        <jats:p>In participating practices (<jats:italic>n<\/jats:italic>\u2009=\u20094), dispensing with protocol encouraged reflection on tailored care and selection of various self-management interventions<\/jats:p>\n                      <\/jats:list-item>\n                      <jats:list-item>\n                        <jats:p>A focus on patient preferences, team collaboration and intervention feasibility was associated with high implementation fidelity<\/jats:p>\n                      <\/jats:list-item>\n                    <\/jats:list><\/jats:p>\n                  <\/jats:list-item>\n                  <jats:list-item>\n                    <jats:p>Quantitative:\n<jats:list list-type=\"bullet\">\n                      <jats:list-item>\n                        <jats:p>In patients (<jats:italic>n<\/jats:italic>\u2009=\u2009126), likelihood of complete monitoring decreased significantly after two years (OR 0.2\u00a0(95%\u00a0CI 0.1\u20130.5), <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001)<\/jats:p>\n                      <\/jats:list-item>\n                      <jats:list-item>\n                        <jats:p>Satisfaction decreased slightly (\u2212\u20091.6 (95%\u00a0CI -2.6;-0.6), <jats:italic>p<\/jats:italic>\u2009=\u20090.001)<\/jats:p>\n                      <\/jats:list-item>\n                      <jats:list-item>\n                        <jats:p>Non-significant declines were found in wellbeing (\u2212\u20091.3 (95%\u00a0CI -5.4; 2.9), <jats:italic>p<\/jats:italic>\u2009=\u20090.55) and health status (\u2212\u20093.0 (95%\u00a0CI -7.1; 1.2), <jats:italic>p<\/jats:italic>\u2009=\u20090.16).<\/jats:p>\n                      <\/jats:list-item>\n                    <\/jats:list><\/jats:p>\n                  <\/jats:list-item>\n                <\/jats:list><\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>To tailor diabetes care to individual patients within well-organised practices, we recommend dispensing with protocol while maintaining one structural annual monitoring consultation, combined with the well-supported implementation of feasible self-management interventions. Interventions should be selected and delivered with the involvement of patients and should involve population preferences and solid team collaborations.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12913-021-07198-2","type":"journal-article","created":{"date-parts":[[2021,11,9]],"date-time":"2021-11-09T22:02:17Z","timestamp":1636495337000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Experiences with tailoring of primary diabetes care in well-organised general practices: a mixed-methods study"],"prefix":"10.1186","volume":"21","author":[{"given":"Sytske","family":"van Bruggen","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marise J.","family":"Kasteleyn","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Simone P.","family":"Rauh","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Julia S.","family":"Meijer","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Karin J. 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