Strengths and weaknesses
diabetes mellitus, cardiovascular disorders
RECRUITMENT, RISK OF PREMATURE DEATH, DIABETES MELLITUS, RECRUITMENT, CARDIOVASCULAR DISORDERS
The primary strength of the SOFIA study lies in the thorough theoretical and methodological foundation that formed the development of the coordinated care program. Inspired by the Medical Research Council (MRC) guidelines, a comprehensive co-design phase involving a variety of stakeholders, collection and reviewing of existing evidence in combination with anthropological fieldwork, informed the development of the coordinated care program and the underlying program theory [The fidelity assessment of the extended consultations was based on GP-reported outcomes, which may have led to an overestimation of the performed fidelity in the study. It can be argued that continuous registration of fidelity measures while delivering the intervention serves as a constant reminder to the GPs. This could mean that REDCap registration represents an active intervention element, which might have resulted in elevated fidelity in the study. Lastly, our data only provided insight regarding the extent to which the activities were conducted, but not the quality of the implementation.Recruitment of practices appeared to be a substantial challenge in our study. Other interventional studies conducted in general practice settings have reported recruitment rates varying from 2 to 81% [Similarly, we could not fully eliminate the risk of selective patient recruitment. Despite relatively strict in- and exclusion criteria, a large proportion of patients were excluded due to “other reasons”, suggesting that GPs, to a certain extent, selectively enrolled participants. Numerous electronic medical record systems are used in Danish general practices, which hampers a single, standardized approach to identifying eligible patients, and the accuracy and degree of completeness of patient diagnoses in the medical records are known to present substantial variation [New diagnoses, symptoms, and medication prescriptions were registered in approximately half of the patients in the intervention group, suggesting that the coordinated care program may bring about changes in healthcare provision. However, no new cases of cardiovascular disorders or diabetes mellitus were detected - the conditions that confer the greatest risk of premature death in this patient group [