Physician experiences when discussing the need for additional oral medication with type 2 diabetes patients: Insights from the cross-national IntroDia® study

Individualized care for older adults with diabetes and its relationship with communication, psychosocial self-efficacy, resources and support for self-management and socio-demographics

AIM

To examine the relationship between patient-provider communication, psychosocial patient self-efficacy, resources and support for self-management and socio-demographics within individualized care of older adults with diabetes.

DESIGN

A quantitative study with a cross-sectional survey design.

METHODS

Data were collected from September 2019 to January 2021 using: Individualized Care Scale, The Communication Assessment Tool, The Diabetes Empowerment Scale and The Resources and Support for Self-Management Scale. Patients with either Type 1 or Type 2 diabetes mellitus that were 65 years old and over (N = 145) participated in the study.

RESULTS

The most positive aspects of patient-provider communication were respect and creating a comfortable environment for the patient. A significant relationship was observed between patients' perceptions and support of individualized care and diabetes-related measures. Effective communication was the main factor associated with support for individualizing care, and together with education level, empowerment and access to resources, explained 23% of the variance.

Patient-physician interpersonal processes of care at the time of diabetes treatment intensification and their links to patient outcomes

OBJECTIVE

To investigate how patient-physician interpersonal processes of care are related to levels of diabetes-related distress, diabetes medication-taking behavior, and HbA1c during conversations with patients about intensifying medication.

METHODS

We randomly recruited 1270 patients from diabetes specialty clinics in Tehran, Iran who were taking an additional oral diabetes medication or starting insulin during the prior 3 months. This interviewer-administered cross-sectional survey assessed multiple aspects of patient-physician interpersonal processes, diabetes-related distress, and diabetes medication-taking. Clinical history and HbA1c were collected from electronic medical records. Regression estimates and Structural Equation Modeling were used to test associations.

RESULTS

Some communication scales indicated a significant relationship with total diabetes distress (P < 0.001). Diabetes medication-taking was associated with less diabetes distress (adjusted odds ratio [aOR]=0.45, P < 0.001), lower Hurried Communication (aOR=0.72, P = 0.013), higher Elicited Concerns (aOR=1.30, P = 0.012), and higher Explained Results (aOR=1.41, P < 0.001) scores. SEM analyses showed medication-taking behavior was associated with a 0.68 decrease in HbA1c. Hurried Communication and diabetes distress were directly associated with HbA1c.

CONCLUSION

Aspects of patient-physician interpersonal processes at the time of intensifying diabetes treatment may be related to experiencing less distress, effective medication-taking, and improved HbA1c.

PRACTICE IMPLICATIONS

The results are intended to inform communication strategies that physicians might incorporate into practice.