Abstract
Objective. This study aims to examine the relationship of diabetes care processes and patient outcomes with an expanded set of indicators regarding patient-oriented care delivery, such as treatment satisfaction, the quality of patient-physician relationship, and a wider range of patient outcomes such as self-management, health behaviour, disease-related burden, and health-related quality of life (HRQL). Methods. The study population consisted of 486 participants with type 2 diabetes in two population-based follow-up surveys, conducted in 2003 to 2005 and 2006 to 2008 in Southern Germany. Data were self-reported and questionnaire-based, including the SF-12 for HRQL. Multiple regression models were used to identify associations between care processes and outcomes with adjustment for confounders. Results. Frequent medical examinations increased the likelihood of self-monitoring activities, such as foot care. A positive patient experienced relationship with their physician is associated with higher adherence to medical recommendations, such as medication intake, and the score of the SF-12 mental component. Participants with diabetes-related complications reported higher levels of medical examinations and multiprofessional care. Conclusions. Indicators of patient-oriented care should become an indispensable part of diabetes clinical practice guidelines with the aim of striving for more effective support of patients.
Highlights
Type 2 diabetes mellitus (T2DM) is a major global chronic disease with immense and increasing healthcare costs and a high disease burden
About half of the sample was treated with oral hypoglycemic agents (OHA) (n = 259, 53%), with the remainder divided between those on insulin only and insulin combination treatment (N = 111, 23%) and those without antidiabetic medication (N = 116, 24%)
Patient-experienced positive relationship with physician is associated with higher adherence to medical recommendations, for example, medication and the SF-12 mental component score
Summary
Type 2 diabetes mellitus (T2DM) is a major global chronic disease with immense and increasing healthcare costs and a high disease burden. Complications are the main driver of diabetes care costs [1, 2]. There is an indispensable need to study how diabetes care can further be improved to limit the disease burden and costs. Health care systems attempt to deal with chronic diseases by standardizing treatment and clinical practice. Important policy strategies include the development of national clinical practice guidelines and indicators for the quality of care [4,5,6,7]. A review of observational studies examining the relationship between guideline-defined diabetes processes and health outcomes notes that effects are often surprisingly small and inconsistent [8]
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