Abstract
BackgroundPhysician practical support (e.g. setting goals, pro-active follow-up) and communicative support (e.g., empathic listening, eliciting preferences) have been hypothesized to influence diabetes outcomes.MethodsIn a prospective observational study, patients rated physician communicative and practical support using a modified Health Care Climate Questionnaire. We assessed whether physicians' characteristic level of practical and communicative support (mean across patients) and each patients' deviation from their physician's mean level of support was associated with glycemic control outcomes. Glycosylated haemoglobin (HbA1c) levels were measured at baseline and at follow-up, about 2 years after baseline.ResultsWe analysed 3897 patients with diabetes treated in nine primary care clinics by 106 physicians in an integrated health plan in Western Washington, USA. Physicians' average level of practical support (based on patient ratings of their provider) was associated with significantly lower HbA1c at follow-up, controlling for baseline HbA1c (p = .0401). The percentage of patients with "optimal" and "poor" glycemic control differed significantly across different levels of practical support at follow (p = .022 and p = .028). Communicative support was not associated with differences in HbA1c at follow-up.ConclusionThis observational study suggests that, in community practice settings, physician differences in practical support may influence glycemic control outcomes among patients with diabetes.
Highlights
IntroductionPhysician practical support (e.g. setting goals, pro-active follow-up) and communicative support (e.g., empathic listening, eliciting preferences) have been hypothesized to influence diabetes outcomes
Physician practical support and communicative support have been hypothesized to influence diabetes outcomes
We excluded patients who: did not give their consent to a review of automated medical records (n = 369); did not have two HbA1c tests available at least six months apart (n = 365); did not have valid data for the Health Care Climate Questionnaire (n = 165); did not report their educational level (n = 39); and/or whose primary care physician had fewer than five patients with diabetes included in the study (n = 4 patients)
Summary
Physician practical support (e.g. setting goals, pro-active follow-up) and communicative support (e.g., empathic listening, eliciting preferences) have been hypothesized to influence diabetes outcomes. The Institute of Medicine has called for "patient-centered" approaches to care, for patients with major chronic conditions such as diabetes [2]. A key question is how primary care physicians can achieve patient-centered care in ways that improved clinical outcomes. An approach that affirms the patient's capacity to identify and learn to solve their own problems relies on a patientcentered consultation style and effective communication between doctor and patient [3]. Many primary care physicians have been trained to employ these techniques in patient care. Evidence across studies is inconsistent regarding whether doctor-patient communication that promotes patient autonomy and self-management can, by itself, improve clinical outcomes [4,5]
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