| Autor: |
Meinbresse, Molly K., Ziemer, David C., Arrington, Bretia, Phillips, Lawrence S., Tsui, Circe W., Singaram, Thenmozhi, Korupolu, Radha, Dames, Faye, Barnes, Catherine S. |
| Předmět: |
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| Zdroj: |
Diabetes; Jun2007 Supplement 1, Vol. 56, pA225-A225, 1/4p |
| Abstrakt: |
Diabetes management requires good patient-provider communication, but outcomes can be limited by "clinical inertia" -- failure of providers to intensify therapy when indicated. Since patients are often passive during office visits, we asked whether use of a wallet-sized "A1C questions" card could empower patients to improve communication, and help overcome clinical inertia. In a pilot study as part of the ongoing Patient Empowerment to Improve Diabetes Care (PEIDiC) program, 148 subjects were randomly assigned to CARD vs. Control. The card had 3 questions for discussion: "What should my A1C be to stay healthy?"; "What is my A1C?"; and "What can we do to get my A1C better?" CARD subjects practiced speaking the questions and were encouraged to use the card during visits with providers; 103 subjects completed a survey after visits. The subjects had mean age 57 yr and diabetes duration 13 yr. Population was 67% female and 97% African-American, with mean BMI 34.9 and A1C 8.1%; 95% used insulin. Sixty percent of CARD subjects said they used the card during visits with providers, and 96% of those who used the card reported that it improved communication; females were more likely than males to use the card (OR=2.5) and initiate discussions (OR=1.6) with providers (both p=ns). CARD subjects were more likely than Controls to know the A1C goal following their visits (OR=9.8, p=0.001), and to say that they initiated A1C discussions with providers (OR=8.4, p<0.0005). When glucose was elevated, providers intensified therapy both more often (OR=1.89, p=ns) and by higher amounts (2.0 vs. 1.4 "steps", p=ns) for CARD vs. Control subjects. Conclusion: Instruction in use of a simple "A1C questions" card increased patient initiation of discussions with providers, improved A1C knowledge, and may also help motivate providers to intensify therapy appropriately. These findings support the concept that focused patient-provider communication is important in empowering patients to help prompt providers to overcome their clinical inertia and act to improve control. ADA-Funded Research [ABSTRACT FROM AUTHOR] |
| Databáze: |
Complementary Index |
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