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Diabetes Res Clin Pract. 2019 Jan 24. pii: S0168-8227(18)30824-6. doi: 10.1016/j.diabres.2019.01.020. [Epub ahead of print]

Physician-patient communication at prescription of an additional oral drug for type 2 diabetes and its links to patient outcomes - new findings from the global IntroDia® study.

Author information

1
Division of Endocrinology and Metabolism, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA; Veterans Affairs Medical Center, 3350 La Jolla Village Dr, San Diego, CA 92161, USA. Electronic address: svedelman@vapop.ucsd.edu.
2
The Michener Institute of Education at UHN, 222 St. Patrick Street, Toronto, Ontario M5T 1V4, Canada. Electronic address: ibelton@telus.net.
3
Somerset Partnership NHS Foundation Trust, 2nd Floor, Mallard Court, Express Park, Bristol Road, Bridgwater, Somerset TA6 4RN, United Kingdom. Electronic address: Su.Down@sompar.nhs.uk.
4
Prince Sultan Military Medical City, PO Box 7897, Riyadh 11159, Saudi Arabia. Electronic address: drausalzaid@hotmail.com.
5
Rotherham Institute for Obesity, and Clifton Medical Centre, Doncaster Gate, Rotherham, South Yorkshire S65 1DA, United Kingdom. Electronic address: mcapehorn@yahoo.co.uk.
6
Boehringer Ingelheim Pharmaceuticals, Inc., 900 Ridgebury Road, PO Box 368, Ridgefield, CT 06877, USA. Electronic address: victoria.gamerman@boehringer-ingelheim.com.
7
Boehringer Ingelheim GmbH, Binger Straße 173, D-55216 Ingelheim am Rhein, Germany. Electronic address: friederike.nagel@boehringer-ingelheim.com.
8
Boehringer Ingelheim International GmbH, Binger Straße 173, D-55216 Ingelheim am Rhein, Germany. Electronic address: jisoo.lee@boehringer-ingelheim.com.
9
Boehringer Ingelheim International GmbH, Binger Straße 173, D-55216 Ingelheim am Rhein, Germany. Electronic address: james.emmerson@boehringer-ingelheim.com.
10
Department of Psychiatry, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA; Behavioral Diabetes Institute, 5405 Oberlin Drive, Suite 100, San Diego, CA 92121, USA. Electronic address: whp@behavioraldiabetes.org.

Abstract

AIMS:

To investigate experiences of people with type 2 diabetes (T2DM) at the clinic visit when an additional oral antidiabetes drug (OAD) is prescribed, and how this affects their quality of life, self-management and key outcomes.

METHODS:

We surveyed adults with T2DM from a large multinational study of patient-physician communication during early T2DM treatment (IntroDia®). We examined their experiences when an additional OAD is prescribed ("add-on") after initial OAD monotherapy, focusing on 24 key conversational elements, overall patient-perceived communication quality (PPCQ), and associations with current patient-reported outcomes. The links between PPCQ and people's efforts to delay add-on therapy were also assessed.

RESULTS:

4235 people with T2DM prescribed an additional OAD, or a combination of two, were analysed. Exploratory factor analyses of the conversational elements during add-on yielded three coherent, meaningful factors: Encouraging (Cronbach's α=0.62), Collaborative (α=0. 81), and Discouraging (α=0.81). PPCQ was positively associated with Encouraging (β=+1.252, p<0.001) and Collaborative (β=+1.206, p<0.001), but negatively associated with Discouraging (β=-0.895, p<0.001). Better PPCQ at add-on was associated with less diabetes distress, greater well-being and better self-care at the present time. Approximately 20% of people bargained (two-thirds successfully) with their physician to delay additional medication. Non-bargaining individuals reported significantly better mean PPCQ, diabetes distress, well-being and self-care than those who bargained.

CONCLUSIONS:

Encouraging and patient-inclusive conversations at add-on moments may improve patient well-being and self-care outcomes. People with T2DM who attempted to delay additional medication reported poorer PPCQ and outcomes.

KEYWORDS:

Patient survey; Patient-reported outcomes; Physician-patient communication; Psychological well-being; Type 2 diabetes

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