- Patient-centered care may improve diabetes self-management and patients’ quality of life, and could also play a significant role in shaping self-care behaviors, according to a new study published in Diabetes Technology & Therapeutics.
With mixed evidence for the role of patient-centered care in patient outcomes, researchers set out to understand the relationship between patient-centered care and glycemic control to better determine whether this is a legitimate strategy to improve care for Type 2 diabetics.
The team recruited 615 adults with Type 2 diabetes from two southeastern primary care clinics to evaluate whether there was an association between patient-centered care, diabetes self-care, glycemic control, and quality of life.
“Patient-centered care (PCC) is a prominent and emerging healthcare reform effort designed to provide respectful and preferential care that aligns with personal values in decision-making,” the authors wrote. “Patient-centeredness seeks to improve the functioning of healthcare organizations, and ultimately improve health outcomes of noncommunicable diseases such as diabetes.”
An estimated 29.1 million Americans -- 9.3 percent of the US population -- have been diagnosed with diabetes, according to the Centers for Disease Control (CDC). The International Diabetes Federation also notes that the number of people impacted worldwide by diabetes is expected to rise from 387 million in 2013, to 592 million by 2035.
Researchers hypothesized that there would be a link between more patient-centered care and increased diabetes knowledge, better self-care, improved glycemic control and a higher quality of life.
Patients who consented to the study were asked to provide demographic information, social determinants of health, self-care behaviors, and comorbidities. Patients’ most recent HbA1c test results were abstracted from medical records.
Researchers used seven questions from the Picker-Commonwealth Survey of Patient-Centered Ambulatory Care to assess how well their providers delivered patient-centered care:
- Did patients have enough time to explain the reason for visiting with their physician?
- Did patients receive understandable answers to their questions?
- Did patients feel the physician had enough time to answer questions?
- Were patients asked how relationships or living situations impacted their health?
- Did patients feel they received the appropriate amount of information from their providers?
- Were there any questions about their care patients did not get a chance to ask?
- Were patients involved in the decision-making process of their care as much as they would like?
The participants also shared information on their diet and exercise habits as well as blood glucose testing, medication adherence, and screenings for lower limb problems.
Researchers also used a 24-item questionnaire to evaluate diabetes knowledge.
The study evaluated both the physical and mental quality of life of patients using 12-point questionnaires. Patients were asked questions ranging from how often their physical health limits their ability to take part in various activities, and how often emotional problems would lead to them accomplishing less than they would like.
Researchers found that patient-centered care was strongly associated with better quality of life (QOL) and self-care behaviors.
However, researchers did not find any significant association between patient-centered care and glycemic control or exercise.
“Given the importance of self-care behaviors in maintaining glycemic control and limiting complications, these findings suggest a need for improved quality of care and focused patient-centered efforts in patients with specific risk profiles,” the authors wrote. “It is important to identify potential barriers and obstacles experienced by patients when integrating self-care into their normal routines.”
“Self-care behaviors, including medication adherence, diet, blood sugar testing, and foot care, are imperative for effective management of type 2 diabetes,” the study continued. “Thus, the positive relationship between PCC and self-care behaviors is promising.
The researchers noted that improved patient-provider relationships, as well as more expensive patient education about chronic disease management, are likely to help with diabetes management. Patients with higher average HbA1c readings may also be more likely to benefit from patient-centered education and care, the study added.
“As healthcare systems are being redesigned to be more patient centric, it is important to ensure that all aspects address these needs, rather than simply one part of the medical care process. For example, systems that support patient autonomy, engaging and coordinating care with providers, and the ability to gather and use feedback, may be just as important as a patient-centered primary care visit,” the authors added.
Overall, researchers concluded that patient-centered care may lead to an increase in satisfaction, improved clinical and behavioral outcomes, and more appropriate use of medical services for diabetes patients.
“Evidence suggests that patients are gradually becoming more interested in receiving health information to serve as partners in their care and collaborators in treatment decision-making; however, this will require providers to understand patient preferences and perspectives of being involved in their personal care and to consider that patient knowledge, skills, and experiences may vary significantly,” the authors wrote.
“This is an important area of future work as both physical and mental components of QOL are important to promote,” the study concluded.