A cluster trial to increase uptake of the NHS-DPP in women with a history of gestational diabetes mellitus (GDM)
Gestational diabetes mellitus
Practices randomised into the intervention arm will also nominate a member of the administration staff to attend a one-hour training session on running the search and sending the text messages. Once the search is completed, practices will send the target patients the first text message. This initial text message will establish that (1) the patients are at an increased risk of T2DM and heart disease due to their GDM diagnosis, and (2) that by self-referring themselves into the NHS-DPP they will be able to get help with implementing lifestyle changes that help to mitigate this risk. Importantly, the messages will include patients' NHS numbers for them to include this in their self-referral form. Two weeks after the first text message is sent, a second text message will be sent, reminding patients to self-refer and of their NHS numbers. Anonymised individual-level data will be obtained through the practices and/or NHS-DPP database. The outcomes regarding patient attendance and referral rates will be obtained on (a) the total number of women in the practice that have had a GDM diagnosis, (b) whether these patients have a recorded referral to the NHS-DPP (c) the number of sessions attended by target patients. The final dataset will be requested at the end of follow-up for all practices (15-month follow up per practice). In this study, baseline is defined as uptake of the programme three months prior to randomisation. As for follow-up, this is defined here as being fifteen months after running the search for control practices, or fifteen months after the date of the second text message for intervention practices.
General practices: 1. Practice has at least 5000 patients registered All practices will be asked to run a search of their patient records for women who meet the inclusion criteria and do not meet the exclusion criteria. The inclusion criteria are: 1. Women 2. Aged 18 years or over 3. Any history of GDM
The practices may not enter the study if the following apply: 1. Practice identifies less than 8 eligible patients 2. Practice currently sends reminders to women with a history of GDM to refer to the NHS-DPP 3. Taking part in another research study or service evaluation exploring the use of reminders to increase the uptake of NDPP to women with a history of GDM All practices will be asked to run a search of their patient records for women who meet the inclusion criteria and do not meet the exclusion criteria. The exclusion criteria are: 1. Recorded history of any other diabetes 2. Previously referred to or attended the NHS-DPP 3. Have a diagnosis of non-diabetic hyperglycaemia in the past 12 months 4. Have requested not to be contacted via SMS by their GP practice 5. Receiving palliative care 6. Have opted out of use of their data for research purposes 7. Any other reason for which the GP practice judges it is not appropriate to target the patient as part of this trial