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

Patient Educ Couns. 2021 Jul;104(7):1659-1667. doi: 10.1016/j.pec.2020.12.008. Epub 2020 Dec 25.

Abstract

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.

Keywords: Communication; Diabetes medication-taking behavior; Patient-physician interpersonal processes of care; Treatment intensification; Type 2 diabetes mellitus.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Cross-Sectional Studies
  • Diabetes Mellitus, Type 2*
  • Glycated Hemoglobin / analysis
  • Humans
  • Iran
  • Physician-Patient Relations
  • Physicians*

Substances

  • Glycated Hemoglobin A