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When do patients and their physicians agree on diabetes treatment goals and strategies, and what difference does it make?

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Abstract

BACKGROUND: For patients with chronic illnesses, it is hypothesized that effective patient-provider collaboration contributes to improved patient self-care by promoting greater agreement on patient-specific treatment goals and strategies. However, this hypothesis has not been tested in actual encounters of patients with their own physicians.

OBJECTIVE: To assess the extent to which patients with type 2 diabetes agree with their primary care providers (PCPs) on diabetes treatment goals and strategies, the factors that predict agreement, and whether greater agreement is associated with better patient self-management of diabetes.

DESIGN: One hundred twenty-seven pairs of patients and their PCPs in two health systems were surveyed about their top 3 diabetes treatment goals (desired outcomes) and strategies to meet those goals. Using several measures to evaluate agreement, we explored whether patient characteristics, such as education and attitudes toward treatment, and patient-provider interaction styles, such as shared decision making, were associated with greater agreement on treatment goals and strategies. We then examined whether agreement was associated with higher patient assessments of their diabetes care self-efficacy and self-management.

RESULTS: Overall, agreement on top treatment goals and strategies was low (all κ were less than 0.40). In multivariable analyses, however, patients with more education, greater belief in the efficacy of their diabetes treatment, and who shared in treatment decision making with their providers were more likely to agree with their providers on treatment goals or strategies. Similarly, physician reports of having discussed more content areas of diabetes self-care were associated with greater agreement on treatment strategies. In turn, greater agreement on treatment goals and strategies was associated both with higher patient diabetes care self-efficacy and assessments of their diabetes self-management.

CONCLUSION: Although patients and their PCPs in general had poor agreement on goals and strategies for managing diabetes, agreement was associated with higher patient self-efficacy and assessments of their diabetes self-management. This supports the hypothesis that enhancing patient-provider agreement on both overall treatment goals and specific strategies to meet these goals may lead to improved patient outcomes.

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Authors and Affiliations

  1. Veterans Affairs Center for Practice Management and Outcomes Research, VA Ann Arbor Healthcare System, 48113-0170, Ann Arbor, MI

    Michele Heisler MD, MPA, Sandeep Vijan MD, MS, Peter A. Ubel MD, Steven J. Bernstein MD, MPH & Timothy P. Hofer MD, MS

  2. Department of Internal Medicine, University of Michigan School of Medicine, Ann Arbor, Mich

    Michele Heisler MD, MPA, Sandeep Vijan MD, MS, Peter A. Ubel MD, Steven J. Bernstein MD, MPH & Timothy P. Hofer MD, MS

  3. Michigan Diabetes Research and Training Center, University of Michigan School of Medicine, Ann Arbor, Mich

    Michele Heisler MD, MPA, Sandeep Vijan MD, MS & Robert M. Anderson EdD

  4. Department of Medical Education, University of Michigan School of Medicine, Ann Arbor, Mich

    Robert M. Anderson EdD

Authors
  1. Michele Heisler MD, MPA
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  2. Sandeep Vijan MD, MS
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  3. Robert M. Anderson EdD
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  4. Peter A. Ubel MD
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  5. Steven J. Bernstein MD, MPH
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  6. Timothy P. Hofer MD, MS
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Additional information

This work was supported by The Department of Veterans Affairs (VA) Health Services Research & Development (HSR & D) Service, The Robert Wood Johnson Clinical Scholars Program, and by NIH grants #1 R18 DK062323-01 and #5P60-DK20572. Dr Vijan is a VA HSR & D Career Development awardee. The views expressed herein do not necessarily represent those of The Robert Wood Johnson Foundation or The Department of Veterans Affairs.

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Heisler, M., Vijan, S., Anderson, R.M. et al. When do patients and their physicians agree on diabetes treatment goals and strategies, and what difference does it make?. J GEN INTERN MED 18, 893–902 (2003). https://doi.org/10.1046/j.1525-1497.2003.21132.x

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  • DOI: https://doi.org/10.1046/j.1525-1497.2003.21132.x

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