Table 1 The obligatory and the optional components of the EMPOWER-PAR intervention and the related CCM elements

CCM elements

Obligatory EMPOWER-PAR Intervention

Target level

 • Organisation of Health Care

 • Delivery System Design

Creating/Strengthening a CDM Team-a multidisciplinary team led by the FMS to improve coordination of care for T2DM and co-existing CV risk factors

Primary Care Providers

 • Decision Support

Utilising the national Clinical Practice Guidelines (CPG) for T2DM to aid management and prescribing

Primary Care Providers

 • Self-Management Support

Utilising the Global CV Risks Self-Management Booklet to support patients self-management

T2DM Patients

CCM Elements

Optional EMPOWER-PAR Intervention

Target Level

 • Clinical Information System

Utilising clinical information system and conducting clinical audits to track progress through reporting outcomes to patients and providers

Primary Care Providers

 • Community Resources and Policy

Utilising community resources to support and sustain care

Primary Care Providers