HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Heisler, M. Articles by Hayward, R. A. Search for Related Content PubMed PubMed Citation Articles by Heisler, M. Articles by Hayward, R. A.

Does Physician Communication Influence Older Patients' Diabetes Self-Management and Glycemic Control? Results From the Health and Retirement Study (HRS)

¹ Veterans Affairs Center for Practice Management & Outcomes Research, VA Ann Arbor Healthcare System, Michigan.² Department of Internal Medicine, University of Michigan Medical School, Ann Arbor.³ Michigan Diabetes Research and Training Center, Ann Arbor.⁴ University of Michigan School of Medicine, Ann Arbor.⁵ Institute for Social Research, University of Michigan, Ann Arbor.

Address correspondence to Michele Heisler, MD, MPA, VA Center for Practice Management and Outcomes Research, University of Michigan, Internal Medicine, 2215 Fuller Road, 11H, Ann Arbor, Michigan 48109. E-mail: mheisler{at}med.umich.edu

Background. Effective chronic disease self-management among older adults is crucial for improved clinical outcomes. We assessed the relative importance of two dimensions of physician communication—provision of information (PCOM) and participatory decision-making (PDM)—for older patients' diabetes self-management and glycemic control.

Methods. We conducted a national cross-sectional survey among 1588 older community-dwelling adults with diabetes (response rate: 81%). Independent associations were examined between patients' ratings of their physician's PCOM and PDM with patients' reported diabetes self-management (medication adherence, diet, exercise, blood glucose monitoring, and foot care), adjusting for patient sociodemographics, illness severity, and comorbidities. Among respondents for whom hemoglobin A1c (HbA1c) values were available (n = 1233), the relationship was assessed between patient self-management and HbA1c values.

Results. In separate multivariate regressions, PCOM and PDM were each associated with overall diabetes self-management (p <.001) and with all self-management domains (p <.001 in all models), with the exception of PDM not being associated with medication adherence. In models with both PCOM and PDM, PCOM alone predicted medication adherence (p =.001) and foot care (p =.002). PDM alone was associated with exercise and blood glucose monitoring (both p <.001) and was a stronger independent predictor than PCOM of diet. Better patient ratings of their diabetes self-management were associated with lower HbA1c values (B = –.10, p =.005).

Conclusion. Among these older adults, both their diabetes providers' provision of information and efforts to actively involve them in treatment decision-making were associated with better overall diabetes self-management. Involving older patients in setting chronic disease goals and decision-making, however, appears to be especially important for self-care areas that demand more behaviorally complex lifestyle adjustments such as exercise, diet, and blood glucose monitoring.