Re-Think the Strip: de-implementing a low value practice in primary care
Abstract Background Self-monitoring of blood glucose (SMBG) is a low value health care practice that does not benefit most patients with non-insulin treated type 2 diabetes (T2DM). This paper evaluates Re-Think the Strip (RTS), a multi-component study aimed at de-implementing SMBG among non-insulin...
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BMC
2025-04-01
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| Series: | BMC Primary Care |
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| Online Access: | https://doi.org/10.1186/s12875-025-02781-6 |
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| author | Katrina E. Donahue Marcella H. Boynton Jennifer Leeman Jennifer Rees Erica Richman Kathleen Mottus Lisa P. Spees Maihan B. Vu April B. Reese Hazel Tapp Adam Lee Asia Johnson Rebecca J. Cleveland Laura A. Young |
| author_facet | Katrina E. Donahue Marcella H. Boynton Jennifer Leeman Jennifer Rees Erica Richman Kathleen Mottus Lisa P. Spees Maihan B. Vu April B. Reese Hazel Tapp Adam Lee Asia Johnson Rebecca J. Cleveland Laura A. Young |
| author_sort | Katrina E. Donahue |
| collection | DOAJ |
| description | Abstract Background Self-monitoring of blood glucose (SMBG) is a low value health care practice that does not benefit most patients with non-insulin treated type 2 diabetes (T2DM). This paper evaluates Re-Think the Strip (RTS), a multi-component study aimed at de-implementing SMBG among non-insulin treated T2DM patients in primary care. Methods This study used a pre-post design to evaluate the effectiveness and implementation of Re-Think the Strip in 20 primary care clinics with a comparison group of 34 clinics within one health system. De-implementation strategies were implemented over 12 months and practices were followed for 18 months. Results There was an overall decrease in the odds of receiving a prescription for diabetes testing supplies (i.e., test strips and/or lancets) between the baseline and 12-month intervention follow-up for intervention and comparison clinics (OR 0.96, 95% CI 0.94, 0.98). However, there was no statistically significant difference in prescribing between the intervention and comparison clinics. In sensitivity analyses, a small intervention effect was observed for those patients newly diagnosed with T2DM or newly assigned to a study clinic (OR = 0.97, 95% CI 0.95, 1.00). Conclusions De-implementation strategies are feasible in primary care practices. Although prescriptions for SMBG decreased in intervention practices, they also decreased in the comparison practices. Newly diagnosed patients or new patients may be more receptive to de-implementation. Other factors, including the COVID-19 pandemic and baseline prescribing rates may have limited the effectiveness of the RTS de-implementation strategy. |
| format | Article |
| id | doaj-art-a0c99d47c9a44904adc216fbb074cfa5 |
| institution | OA Journals |
| issn | 2731-4553 |
| language | English |
| publishDate | 2025-04-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Primary Care |
| spelling | doaj-art-a0c99d47c9a44904adc216fbb074cfa52025-08-20T01:56:09ZengBMCBMC Primary Care2731-45532025-04-0126111010.1186/s12875-025-02781-6Re-Think the Strip: de-implementing a low value practice in primary careKatrina E. Donahue0Marcella H. Boynton1Jennifer Leeman2Jennifer Rees3Erica Richman4Kathleen Mottus5Lisa P. Spees6Maihan B. Vu7April B. Reese8Hazel Tapp9Adam Lee10Asia Johnson11Rebecca J. Cleveland12Laura A. Young13Department of Family Medicine, University of North Carolina at Chapel HillDepartment of Medicine, Division of General Medicine & Clinical Epidemiology, University of North Carolina at Chapel HillSchool of Nursing, University of North Carolina at Chapel HillNorth Carolina Translational and Clinical Sciences Institute, University of North Carolina at Chapel HillCecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel HillNorth Carolina Translational and Clinical Sciences Institute, University of North Carolina at Chapel HillDepartment of Health Policy and Management, University of North Carolina at Chapel HillCenter for Health Promotion and Disease Prevention, University of North Carolina at Chapel HillDiabetes Team, National Association of Chronic Disease DirectorsDepartment of Family Medicine, Atrium HealthNorth Carolina Translational and Clinical Sciences Institute, University of North Carolina at Chapel HillCooperative Studies Program Epidemiology Center, Veteran Affairs Health Care SystemDivision of Rheumatology, Allergy and Immunology, University of North Carolina at Chapel HillDepartment of Medicine, Division of Endocrinology and Metabolism, University of North Carolina at Chapel HillAbstract Background Self-monitoring of blood glucose (SMBG) is a low value health care practice that does not benefit most patients with non-insulin treated type 2 diabetes (T2DM). This paper evaluates Re-Think the Strip (RTS), a multi-component study aimed at de-implementing SMBG among non-insulin treated T2DM patients in primary care. Methods This study used a pre-post design to evaluate the effectiveness and implementation of Re-Think the Strip in 20 primary care clinics with a comparison group of 34 clinics within one health system. De-implementation strategies were implemented over 12 months and practices were followed for 18 months. Results There was an overall decrease in the odds of receiving a prescription for diabetes testing supplies (i.e., test strips and/or lancets) between the baseline and 12-month intervention follow-up for intervention and comparison clinics (OR 0.96, 95% CI 0.94, 0.98). However, there was no statistically significant difference in prescribing between the intervention and comparison clinics. In sensitivity analyses, a small intervention effect was observed for those patients newly diagnosed with T2DM or newly assigned to a study clinic (OR = 0.97, 95% CI 0.95, 1.00). Conclusions De-implementation strategies are feasible in primary care practices. Although prescriptions for SMBG decreased in intervention practices, they also decreased in the comparison practices. Newly diagnosed patients or new patients may be more receptive to de-implementation. Other factors, including the COVID-19 pandemic and baseline prescribing rates may have limited the effectiveness of the RTS de-implementation strategy.https://doi.org/10.1186/s12875-025-02781-6Practice-based researchDe-implementationGlucose monitoringImplementation and disseminationDiabetes |
| spellingShingle | Katrina E. Donahue Marcella H. Boynton Jennifer Leeman Jennifer Rees Erica Richman Kathleen Mottus Lisa P. Spees Maihan B. Vu April B. Reese Hazel Tapp Adam Lee Asia Johnson Rebecca J. Cleveland Laura A. Young Re-Think the Strip: de-implementing a low value practice in primary care BMC Primary Care Practice-based research De-implementation Glucose monitoring Implementation and dissemination Diabetes |
| title | Re-Think the Strip: de-implementing a low value practice in primary care |
| title_full | Re-Think the Strip: de-implementing a low value practice in primary care |
| title_fullStr | Re-Think the Strip: de-implementing a low value practice in primary care |
| title_full_unstemmed | Re-Think the Strip: de-implementing a low value practice in primary care |
| title_short | Re-Think the Strip: de-implementing a low value practice in primary care |
| title_sort | re think the strip de implementing a low value practice in primary care |
| topic | Practice-based research De-implementation Glucose monitoring Implementation and dissemination Diabetes |
| url | https://doi.org/10.1186/s12875-025-02781-6 |
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