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Diabetes Educ. 2011 Jan-Feb;37(1):78-84. doi: 10.1177/0145721710388427. Epub 2010 Nov 29.

Diabetes oral medication initiation and intensification: patient views compared with current treatment guidelines.

Author information

1
The Division of General Medicine, Boston, Massachusetts (Dr Grant, Dr Pabon-Nau, Ms Pandiscio)
2
Massachusetts General Hospital, Boston, and Harvard Medical School, Boston, Massachusetts (Dr Grant, Dr Pabon-Nau, Dr Park)
3
The Mongan Institute for Health Policy, Boston, Massachusetts (Ms Ross, Ms Youatt, Ms Pandiscio, Dr Park),

Abstract

PURPOSE:

The purpose of this study was to compare patient perceptions about medication management with principles underlying American Diabetes Association (ADA) published treatment algorithms.

METHODS:

Six focus groups (4 English and 2 Spanish) were conducted with 50 patients with type 2 diabetes. Patients were asked about their prior experiences with initiating and changing oral medicines. They were also shown a medication plan for a hypothetical patient depicting future potential changes to achieve glycemic control. Coded responses were mapped to 3 concepts implicit in the ADA recommended treatment algorithm: (1) prescribing medicines to achieve A1c goal is beneficial, (2) medical regimens are generally intensified, and (3) intensification should be timely.

RESULTS:

Patient perceptions contrasted markedly with the treatment algorithm: (1) most patients had negative perceptions of medication initiation, viewing this event as evidence of personal failure and an increased burden; (2) patients equated medication intensification with increased risk for diabetes-related complications (rather than a step to reduce future risk) and viewed de-escalation as a primary goal; and (3) no patients expressed concerns about delays in medication intensification. Patients responded very favorably to an individualized medication plan depicting future potential changes.

CONCLUSIONS:

Patients in this study described a conceptual model for medication therapy that contrasted in critical ways from the principles of current treatment guidelines. Underscoring the key role of patient-provider communication, the results suggest that effective counseling should also include an informed discussion of future medication intensification.

PMID:
21115980
PMCID:
PMC3033981
DOI:
10.1177/0145721710388427
[Indexed for MEDLINE]
Free PMC Article

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