Open Access Open Badges Study protocol

Diabetes in rural towns: effectiveness of continuing education and feedback for healthcare providers in altering diabetes outcomes at a population level: protocol for a cluster randomised controlled trial

Christine L Paul12*, Leon Piterman3, Jonathan Shaw4, Catherine Kirby3, Robert W Sanson-Fisher12, Mariko L Carey12, Jennifer Robinson12, Patrick McElduff12 and Isaraporn Thepwongsa3

Author Affiliations

1 Health Behaviour Research group, Priority Research Centre for Health Behaviour, School of Medicine and Public Health, University of Newcastle, HMRI Building, Callaghan, NSW 2308, Australia

2 The Hunter Medical Research Institute, Callaghan, NSW 2308, Australia

3 Office of the Pro Vice-Chancellor (Berwick and Peninsula), Monash University, Building 901, 100 Clyde Road, Berwick, VIC 3806, Australia

4 Baker IDI Heart and Diabetes Institute, PO Box 6492St Kilda Road Central, Melbourne, VIC 8008, Australia

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Implementation Science 2013, 8:30  doi:10.1186/1748-5908-8-30

Published: 13 March 2013



Type 2 diabetes is one of the fastest growing chronic diseases internationally. The health complications associated with type 2 diabetes can be prevented, delayed, or improved via early diagnosis and effective management. This research aims to examine the impact of a primarily web-based educational intervention on the diabetes care provided by general practitioners (GPs) in rural areas, and subsequent patient outcomes. A population-level approach to outcome assessment is used, via whole-town de-identified pathology records.


The study uses a cluster randomised controlled trial with rural communities as the unit of analysis. Towns from four Australian states were selected and matched on factors including rurality, population size, proportion of the population who were Indigenous Australians, and socio-economic status. Eleven pairs of towns from two states were suitable for the trial, and one town from each pair was randomised to the experimental group. GPs in the towns allocated to the experimental group are offered an intervention package comprising education on best practice diabetes care via an on-line active learning module, a moderated discussion forum, access to targeted and specialist advice through an on-line request form, and town-based performance feedback on diabetes monitoring and outcomes. The package is offered via repeated direct mail.


The benefits of the outcomes of the trial are described along with the challenges and limitations associated with the methodology.

Trial registration

Australian New Zealand Clinical Trials Registry: ACTRN12611000553976

Type 2 diabetes mellitus; Cluster randomised controlled trial; Internet; Medical education; General practitioner