Discordance between physician and adolescent assessments of adherence to treatment: influence of HbA1c level. The PEDIAB Collaborative Group
| Autor: | L Du Pasquier-Fediaevsky, N Tubiana-Rufi |
|---|---|
| Rok vydání: | 1999 |
| Předmět: |
Research design
Male Pediatrics medicine.medical_specialty Multivariate analysis genetic structures Adolescent Cross-sectional study Endocrinology Diabetes and Metabolism MEDLINE Diabetes mellitus Surveys and Questionnaires Internal Medicine Medicine Humans Child Advanced and Specialized Nursing Glycated Hemoglobin Physician-Patient Relations business.industry Reproducibility of Results medicine.disease Cross-Sectional Studies Evaluation Studies as Topic Test score Metabolic control analysis Multivariate Analysis Patient Compliance Female France Attribution business Clinical psychology |
| Zdroj: | Diabetes care. 22(9) |
| ISSN: | 0149-5992 |
| Popis: | OBJECTIVE: To compare the subjective assessments (perceptions) of physicians and adolescent diabetic patients on the adolescents' adherence to treatment and to test the hypothesis that the HbA1c level influences physicians' perceptions. RESEARCH DESIGN AND METHODS: In a multicenter cross-sectional survey, 143 adolescents with diabetes (mean age 14.6 years) auto-assessed, while their pediatricians independently assessed, the level of adherence to treatment on a four-point scale. Scores of adherence given by a validated scale and metabolic control (HbA1c) were compared according to those assessments. RESULTS: Agreement between the adherence perceptions from adolescents and physicians was low (kappa = 0.23), and adolescents scored significantly higher (P < 0.001). Mean adherence score to diabetes treatment was significantly higher when the adolescents' perception of their self-care behaviors was good than when it was poor (P = 0.01), but did not significantly differ according to physicians' perception. Mean HbA1c level was significantly lower when the self-care behavior perception was good than when it was poor, both for the adolescents (P = 0.02) and for the physicians (P < 0.001). Multivariate analyses showed that only the adherence scale score was significantly associated with the adolescents' perception (P = 0.015), whereas only HbA1c level was significantly associated with the physicians' perception (P = 0.0008). CONCLUSIONS: By identifying the possible discrepancy between their own assessment of adherence and that of adolescents, and by avoiding the systematic attribution of poor metabolic control to poor adherence, physicians could generate a more confident and collaborative relationship with diabetic adolescents and therefore facilitate adolescents' self-management. |
| Databáze: | OpenAIRE |
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