Resource Requirements for Training Existing Practice Staff to Deliver Diabetes Interventions in a Pragmatic Trial

DENNIS GURFINKEL, MPH
University of Colorado

Pragmatic trials examine effectiveness of health interventions in real-world settings. To enhance relevance and scalability, interventions can be delivered by existing healthcare practice personnel, necessitating implementation strategies such as staff training. Invested in Diabetes is a pragmatic trial of two models of diabetes shared medical appointments (SMA) delivered in primary care settings. SMAs are delivered by care teams including health educators, behavioral health specialists, peer mentors, and providers with prescribing privileges. This abstract describes SMA care team training content, resources, evaluations, and adaptations.

Practice staff and peer mentors recruited to deliver SMAs at 21 primary care sites.

Health educators and behavioral health specialists participated in a 6-hour SMA facilitator training to learn about the project protocols, assigned SMA model, group facilitation skills, and SMA curriculum. Peer mentors participated in a 4-hour training adapted from materials from Peers for Progress; some participated in the general SMA facilitator training. Providers participated in one-hour “lunch & learns.” Training events were summarized via agendas and notes. Adaptations, including number of trainings, content, and style, were documented. Satisfaction surveys were collected after facilitator trainings.

There were 26 facilitator, 9 peer mentor and 13 provider trainings delivered to a total of 166 individuals across 22 practices from 2018-2021. Initially, trainings were held in-person; virtual and hybrid trainings were introduced for those with travel barriers and/or pandemic restrictions. Trainee satisfaction was high in both in-person and virtual delivery, while virtual delivery was easier to schedule and reduced travel time/expenses. Based on satisfaction surveys, trainings began incorporating facilitation techniques and role play rather than just intervention protocol and curriculum. The role of the main trainer changed from investigators to research assistants; the number of research staff present at trainings varied between 4 in earlier iterations to 1-2 later iterations. A total of ~412 hours of research staff time was used for trainings.

Pragmatic trialists should plan for adequate effort and resources to train practice personnel in delivery of an intervention. Notably, plan to offer trainings throughout the course of the study as new staff are identified. Approaches that decrease personnel and time burden, such as virtual and pre-recorded trainings, may optimize use of available resources.