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Dimensions of patient-provider communication and diabetes self-care in an ethnically diverse population

Abstract

BACKGROUND: Patient-provider communication is essential for effective care of diabetes and other chronic illnesses. However, the relative impact of general versus disease-specific communication on self-management is poorly understood, as are the determinants of these 2 communication dimensions.

DESIGN: Cross-sectional survey.

SETTING: Three VA heath care systems, 1 county health care system, and 1 university-based health care system.

PATIENTS: Seven hundred fifty-two diabetes patients were enrolled. Fifty-two percent were nonwhite, 18% had less than a high-school education, and 8% were primarily Spanish-speaking.

MEASUREMENTS AND MAIN RESULTS: Patients’ assessments of providers’ general and diabetes-specific communication were measured using validated scales. Self-reported foot care; and adherence to hypoglycemic medications, dietary recommendations, and exercise were measured using standard items. General and diabetes-specific communication reports were only moderately correlated (r=.35) and had differing predictors. In multivariate probit analyses, both dimensions of communication were independently associated with self-care in each of the 4 areas examined. Sociodemographically vulnerable patients (racial and language minorities and those with less education) reported communication that was as good or better than that reported by other patients. Patients receiving most of their diabetes care from their primary provider and patients with a longer primary care relationship reported better general communication. VA and county clinic patients reported better diabetes-specific communication than did university clinic patients.

CONCLUSIONS: General and diabetes-specific communication are related but unique facets of patient-provider interactions, and improving either one may improve self-management. Providers in these sites are communicating successfully with vulnerable patients. These findings reinforce the potential importance of continuity and differences among VA, county, and university health care systems as determinants of patient-provider communication.

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References

  1. Harris MI. Health care and health status and outcomes for patients with type 2 diabetes. Diabetes Care. 2000;23:754–8.

    PubMed  Article  CAS  Google Scholar 

  2. Saaddine JB, Engelgau MM, Beckles GL, Gregg EW, Thompson TJ, Narayan KM. A diabetes report card for the United States: quality of care in the 1990s. Ann Intern Med. 2002;136:565–74.

    PubMed  Google Scholar 

  3. Goldman DP, Smith JP. Can patient self-management help explain the SES health gradient? Proc Natl Acad Sci USA. 2002;99:10929–34.

    PubMed  Article  CAS  Google Scholar 

  4. Glasgow RE, Anderson RM. In diabetes care, moving from compliance to adherence is not enough. Something entirely different is needed. Diabetes Care. 1999;22:2090–2.

    PubMed  Article  CAS  Google Scholar 

  5. Anderson RM, Funnell MM. Compliance and adherence are dysfunctional concepts in diabetes care. Diabetes Educ. 2000;26:597–604.

    PubMed  CAS  Google Scholar 

  6. Olivarius NF, Beck-Nielsen H, Andreasen AH, Horder M, Pedersen PA. Randomised controlled trial of structured personal care of type 2 diabetes mellitus. BMJ. 2001;323:946–7.

    Article  Google Scholar 

  7. Charman D. Burnout and diabetes: reflections from working with educators and patients. J Clin Psychol. 2000;56:607–17.

    PubMed  Article  CAS  Google Scholar 

  8. Hoover JW. Patient burnout, and other reasons for noncompliance. Diabetes Educ. 1983;9:41–3.

    PubMed  CAS  Google Scholar 

  9. Heisler M, Bouknight RR, Hayward RA. The relative importance of physician communication, participatory decision-making, and patient understanding in diabetes self-management. J Gen Intern Med. 2002;17:243–52.

    PubMed  Article  Google Scholar 

  10. DiMatteo MR. The physician-patient relationship: effects on the quality of health care. Clin Obstet Gynecol. 1994;37:149–61.

    PubMed  Article  CAS  Google Scholar 

  11. Greenfield S, Kaplan S, Ware JE Jr. Expanding patient involvement in care. Effects on patient outcomes. Ann Intern Med. 1985;102:520–8.

    PubMed  CAS  Google Scholar 

  12. Sherbourne CD, Hays RD, Ordway L, DiMatteo MR, Kravitz RL. Antecedents of adherence to medical recommendations: results from the Medical Outcomes Study. J Behav Med. 1992;15:447–68.

    PubMed  Article  CAS  Google Scholar 

  13. Kaplan SH, Greenfield S, Ware JE Jr. Assessing the effects of physician-patient interactions on the outcomes of chronic disease [published erratum] appears in Med Care. 1989;27:S110–27.

    CAS  Google Scholar 

  14. Stewart MA. Effective physician-patient communication and health outcomes: a review. CMAJ. 1995;152:1423–33.

    PubMed  CAS  Google Scholar 

  15. Anderson RM, Funnell MM, Butler PM, Arnold MS, Fitzgerald JT, Feste CC. Patient empowerment. Results of a randomized controlled trial. Diabetes Care. 1995;18:943–9.

    PubMed  Article  CAS  Google Scholar 

  16. Roter DL, Hall JA, Aoki Y. Physician gender effects in medical communication: a meta-analytic review. JAMA. 2002;288:756–67.

    PubMed  Article  Google Scholar 

  17. Sprague-Jones J. Gender effects in physician-patient interaction. In: Lipkin M, Putnam SM, Lazare A, eds. The Medical Interview: Clinical Care, Education, and Research. New York: Springer-Verlag; 1995: 163–71.

    Google Scholar 

  18. Arnold RM, Martin SC, Parker RM. Taking care of patients—does it matter whether the physician is a woman? West J Med. 1988;149:729–33.

    PubMed  CAS  Google Scholar 

  19. Zare N, Sorenson JR, Heeren T. Sex of provider as a variable in effective genetic counseling. Soc Sci Med. 1984;19:671–5.

    PubMed  Article  CAS  Google Scholar 

  20. Linn LS, Cope DW, Leake B. The effect of gender and training of residents on satisfaction ratings by patients. J Med Educ. 1984;59:964–6.

    PubMed  CAS  Google Scholar 

  21. Love MM, Mainous III AG, Talbert JC, Hager GL. Continuity of care and the physician-patient relationship: the importance of continuity for adult patients with asthma. J Fam Pract. 2000;49:998–1004.

    PubMed  CAS  Google Scholar 

  22. Howie JG, Heaney DJ, Maxwell M, Walker JJ, Freeman GK, Rai H. Quality at general practice consultations: cross sectional survey. BMJ. 1999;319:738–43.

    PubMed  CAS  Google Scholar 

  23. Hjortdahl P, Laerum E. Continuity of care in general practice: effect on patient satisfaction. BMJ. 1992;304:1287–90.

    PubMed  CAS  Article  Google Scholar 

  24. Stewart AL, Napoles-Springer A, Perez-Stable EJ. Interpersonal processes of care in diverse populations. Milbank Q. 1999;77:305–39.

    PubMed  Article  CAS  Google Scholar 

  25. Lipkin M, Putnam SM, Lazare A. Three functions of the medical interview. In: The Medical Interview: Clinical Care, Education, and Research. New York: Springer-Verlag; 1995:3–19.

    Google Scholar 

  26. Toobert DJ, Hampson SE, Glasgow RE. The summary of diabetes self-care activities measure: results from 7 studies and a revised scale. Diabetes Care. 2000;23:943–50.

    PubMed  Article  CAS  Google Scholar 

  27. Arsie MP, Marchioro L, Lapolla A, et al. Evaluation of diagnostic reliability of DCA 2000 for rapid and simple monitoring of HbA1c. Acta Diabetol. 2000;37:1–7.

    PubMed  Article  CAS  Google Scholar 

  28. Murray-Garcia JL, Selby JV, Schmittdiel J, Grumbach K, Quesenberry CP Jr. Racial and ethnic differences in a patient survey: patients’ values, ratings, and reports regarding physician primary care performance in a large health maintenance organization. Med Care. 2000;38:300–10.

    PubMed  Article  CAS  Google Scholar 

  29. Collins TC, Clark JA, Petersen LA, Kressin NR. Racial differences in how patients perceive physician communication regarding cardiac testing. Medical Care. 2002;40(1 Suppl):I27–34.

    PubMed  Google Scholar 

  30. Cooper-Patrick L, Gallo JJ, Gonzales JJ, et al. Race, gender, and partnership in the patient-physician relationship. JAMA. 1999;282:583–9.

    PubMed  Article  CAS  Google Scholar 

  31. Meredith LS, Siu AL. Variation and quality of self-report health data. Asians and Pacific Islanders compared with other ethnic groups. Med Care. 1995;33:1120–31.

    PubMed  Article  CAS  Google Scholar 

  32. Harpole LH, Orav EJ, Hickey M, Posther KE, Brennan TA. Patient satisfaction in the ambulatory setting. Influence of data collection methods and sociodemographic factors. J Gen Intern Med. 1996;11:431–4.

    PubMed  Article  CAS  Google Scholar 

  33. Perez-Stable EJ, Napoles-Springer A, Miromontes JM. The effects of ethnicity and language on medical outcomes of patients with hypertension and diabetes. Med Care. 1997;35:1212–9.

    PubMed  Article  CAS  Google Scholar 

  34. Tocher TM, Larson E. The quality of diabetes care for non-English-speaking patients. West J Med. 1998;168:504–11.

    PubMed  CAS  Google Scholar 

  35. Perez-Stable EJ, Napoles-Springer A. Interpreters and communication in the clinical encounter. Am J Med. 2000;108:509–10.

    PubMed  Article  CAS  Google Scholar 

  36. Scott A, Smith RD. Keeping the customer satisfied: issues in the interpretation and use of patient satisfaction surveys. Int J Qual Health Care. 1994;6:353–9.

    PubMed  CAS  Google Scholar 

  37. Sitzia J, Wood N. Patient satisfaction: review of issues and concepts. Soc Sci Med. 1997;45:1829–43.

    PubMed  Article  CAS  Google Scholar 

  38. Zemenuck JK, Hayward RA, Skarupski KA, Katz SJ. Patients’ desires and expectations for medical care: a challenge to improving patient satisfaction. Am J Med Qual. 1999;14:21–7.

    Google Scholar 

  39. Halm EA, Lee C, Chassin MR. Is volume related to outcome in health care? A systematic review and methodologic critique of the literature. Ann Intern Med. 2002;137:511–20.

    PubMed  Google Scholar 

  40. Glasgow RE, Wilson W, McCaul KD. Regimen adherence: a problematic construct in diabetes research. Diabetes Care. 1985;8:300–1.

    PubMed  CAS  Google Scholar 

  41. McNabb WL. Adherence in diabetes: can we define it and can we measure it? Diabetes Care. 1997;20:215–8.

    PubMed  Article  CAS  Google Scholar 

  42. Johnson SB. Methodologic issues in diabetes research: measuring adherence. Diabetes Care. 1992;15:1658–67.

    PubMed  Article  CAS  Google Scholar 

  43. Stewart M. The validity of an interview to assess patients’ drug taking. Am J Prev Med. 1987;25:63–76.

    Google Scholar 

  44. Vermeire E, Hearnshaw H, Van Royen P, Denekens J. Patient adherence to treatment: three decades of research. A comprehensive review. J Clin Pharm Ther. 2001;26:331–42.

    PubMed  Article  CAS  Google Scholar 

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Correspondence to John D. Piette PhD.

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This study was supported by grants from the Department of Veterans Affairs and the Agency for Healthcare Research and Quality. The views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs.

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Piette, J.D., Schillinger, D., Potter, M.B. et al. Dimensions of patient-provider communication and diabetes self-care in an ethnically diverse population. J GEN INTERN MED 18, 624–633 (2003). https://doi.org/10.1046/j.1525-1497.2003.31968.x

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  • DOI: https://doi.org/10.1046/j.1525-1497.2003.31968.x

Key Words

  • diabetes mellitus
  • self-care
  • communication barriers
  • access to care
  • chronic disease management
  • quality of care