Use of a GP-endorsed 12 months' reminder letter to promote uptake of bowel scope screening: protocol for a randomised controlled trial in a hard-to-reach population

The low carb program for people with type 2 diabetes and pre-diabetes - a mixed methods feasibility study of signposting from general practice

Background

Evidence shows type 2 diabetes mellitus (T2DM) can be effectively treated with a reduced-carbohydrate diet to support weight loss. Digital apps are increasingly used to support weight loss, yet little is known about their use as part of general practice diabetes care.

Aim

Determine the feasibility of signposting from routine NHS general practice to a digital weight management tool (Low Carb Program) for patients with T2DM and pre-diabetes.

Design & setting

Mixed-methods feasibility study implemented within routine general practice consultations at four practices in the Midlands, England.

Method

General practices offered signposting to eligible patients attending consultations of any type during a 4-week recruitment period. Rates of offering and accepting signposting were recorded, with program registration, program completion, and self-reported health outcomes (weight, haemoglobin A1C [HbA1c]).

Results

Signposting was offered to 351 patients; 160 (45.6%) accepted, 103 (29.3%) registered with the intervention and 43 (26.9% of patients accepting signposting) completed the programme. GPs reported that signposting added between 1–4 minutes to the consultation length. Patients completing the programme reported greater weight loss (7.2kg versus 1.6kg, P<0.001) and HbA1c improvements (-9.1mmol/mol versus 1.7mmol/mol, P<0.001) compared to those who did not, and were more likely to reduce the number of prescribed diabetes medications in general practice.

Conclusions

Signposting from real-world general practice to the Low CarbProgram is feasible and can potentially improve diabetes outcomes. Further research should explore whether the process of signposting can be enhanced to increase registration, identify whether additional practice-led support leads to increased programme completion, and confirm the intervention’s clinical and cost-effectiveness.

Use of a GP-endorsed non-participant reminder letter to promote uptake of bowel scope screening: A randomised controlled trial in a hard-to-reach population

Previous research suggests that sending non-participants a reminder letter, 1 year after their initial invitation, can improve coverage for bowel scope screening (BSS), also known as flexible sigmoidoscopy screening. We hypothesised that adding a general practitioner's (GPs) endorsement to the reminder letter could improve coverage even further. We conducted a randomised controlled trial in North West London, UK. Participants were screening-eligible men and women who had not responded to their initial BSS invitation at least 12 months prior to the trial period. Eligible adults were randomised in a 1:1 ratio to receive either a GP-endorsed reminder letter, or a standard reminder letter from June to August 2019. Logistic regression models were used to test the effect of the GP endorsement on attendance at BSS, adjusting for sex, clinical commissioning group, and local area socioeconomic deprivation. In total, 1200 participants were enrolled into the study and randomised to either the control (n = 600) or the intervention (n = 600) group. Those who received the GP-endorsed reminder letter were only slightly more likely to attend BSS than those who received the standard reminder letter (4% vs. 3%); this difference was not statistically significant (Adjusted OR = 1.30; 95% CI: 0.69, 2.43). Adding a GP-endorsement to the annual reminder letter did not have an effect on attendance at BSS. One possible explanation for this is that the endorsement used was not personalised enough. Future research should examine stronger GP-endorsements or other methods to promote uptake.