Monday, April 21
Grant Miller: Managerial Incentives in Public Service Delivery
Heisler, Michele, I. Cole, David Weir, E.A. Kerr, and R.A. Hayward. 2007. "Does physician communication influence older patients' diabetes self-management and glycemic control? Results from the Health and Retirement Study (HRS)." Journals of Gerontology Series a-Biological Sciences and Medical Sciences, 62(12): 1435-1442.
Background. Effective chronic disease self-management among older adults is crucial for improved clinical outcomes. We assessed the relative importance of two dimensions of physician communication-provision of information (PCOM) and participatory decision-making (PDM)-for older patients' diabetes self-management and glycemic control. Methods. We conducted a national cross-sectional survey among 1588 older community-dwelling adults with diabetes (response rate: 81 %). Independent associations were examined between patients' ratings of their physician's PCOM and PDM with patients' reported diabetes self-management (medication adherence, diet, exercise, blood glucose monitoring, and foot care), adjusting for patient sociodemographics, illness severity, and comorbidities. Among respondents for whom hemoglobin Alc (HbAlc) values were available (n = 1233), the relationship was assessed between patient self-management and HbAlc values. Results. In separate multivariate regressions, PCOM and PDM were each associated with overall diabetes self-management (p <.001) and with all self-management domains (p <.001 in all models), with the exception of PDM not being associated with medication adherence. In models with both PCOM and PDM, PCOM alone predicted medication adherence (p =.001) and foot care (p =.002). PDM alone was associated with exercise and blood glucose monitoring (both p <.001) and was a stronger independent predictor than PCOM of diet. Better patient ratings of their diabetes self-management were associated with lower HbAlc values (B =-.10, p =.005). Conclusion. Among these older adults, both their diabetes providers' provision of information and efforts to actively involve them in treatment decision-making were associated with better overall diabetes self-management. Involving older patients in setting chronic disease goals and decision-making, however, appears to be especially important for self-care areas that demand more behaviorally complex lifestyle adjustments such as exercise, diet, and blood glucose monitoring.