Dimensions of patient-provider communication and diabetes self-care in an ethnically diverse population

Abstract

Background: Patient-provider communication is essential for effective care of diabetes and other chronic illnesses. However, the relative impact of general versus disease-specific communication on self-management is poorly understood, as are the determinants of these 2 communication dimensions.

Design: Cross-sectional survey.

Setting: Three VA heath care systems, 1 county health care system, and 1 university-based health care system.

Patients: Seven hundred fifty-two diabetes patients were enrolled. Fifty-two percent were nonwhite, 18% had less than a high-school education, and 8% were primarily Spanish-speaking.

Measurements and main results: Patients' assessments of providers' general and diabetes-specific communication were measured using validated scales. Self-reported foot care; and adherence to hypoglycemic medications, dietary recommendations, and exercise were measured using standard items. General and diabetes-specific communication reports were only moderately correlated (r =.35) and had differing predictors. In multivariate probit analyses, both dimensions of communication were independently associated with self-care in each of the 4 areas examined. Sociodemographically vulnerable patients (racial and language minorities and those with less education) reported communication that was as good or better than that reported by other patients. Patients receiving most of their diabetes care from their primary provider and patients with a longer primary care relationship reported better general communication. VA and county clinic patients reported better diabetes-specific communication than did university clinic patients.

Conclusions: General and diabetes-specific communication are related but unique facets of patient-provider interactions, and improving either one may improve self-management. Providers in these sites are communicating successfully with vulnerable patients. These findings reinforce the potential importance of continuity and differences among VA, county, and university health care systems as determinants of patient-provider communication.

Figures

FIGURE 1

Predicted probability of optimal self-care at differing levels of general communication and diabetes-specific communication. Probabilities were calculated based on multivariate, ordinal probit models controlling for patients' sociodemographic characteristics (race, language, gender, age, and educational attainment), clinical characteristics (insulin use, A1c level, hypertension, history of myocardial infarction, and number of diabetes complications), and characteristics of the treatment context (whether the primary provider provides most of the diabetes care, provider gender, length of the primary care relationship, and site of care). A: The probability of “daily” or “almost daily” foot checks. B: The probability of “always” taking diabetes medications as prescribed. C: The probability of “always” following a recommended diet. D: The probability of “daily” exercise.

FIGURE 1

Predicted probability of optimal self-care at differing levels of general communication and diabetes-specific communication. Probabilities were calculated based on multivariate, ordinal probit models controlling for patients' sociodemographic characteristics (race, language, gender, age, and educational attainment), clinical characteristics (insulin use, A1c level, hypertension, history of myocardial infarction, and number of diabetes complications), and characteristics of the treatment context (whether the primary provider provides most of the diabetes care, provider gender, length of the primary care relationship, and site of care). A: The probability of “daily” or “almost daily” foot checks. B: The probability of “always” taking diabetes medications as prescribed. C: The probability of “always” following a recommended diet. D: The probability of “daily” exercise.

FIGURE 1

Predicted probability of optimal self-care at differing levels of general communication and diabetes-specific communication. Probabilities were calculated based on multivariate, ordinal probit models controlling for patients' sociodemographic characteristics (race, language, gender, age, and educational attainment), clinical characteristics (insulin use, A1c level, hypertension, history of myocardial infarction, and number of diabetes complications), and characteristics of the treatment context (whether the primary provider provides most of the diabetes care, provider gender, length of the primary care relationship, and site of care). A: The probability of “daily” or “almost daily” foot checks. B: The probability of “always” taking diabetes medications as prescribed. C: The probability of “always” following a recommended diet. D: The probability of “daily” exercise.

FIGURE 1

Predicted probability of optimal self-care at differing levels of general communication and diabetes-specific communication. Probabilities were calculated based on multivariate, ordinal probit models controlling for patients' sociodemographic characteristics (race, language, gender, age, and educational attainment), clinical characteristics (insulin use, A1c level, hypertension, history of myocardial infarction, and number of diabetes complications), and characteristics of the treatment context (whether the primary provider provides most of the diabetes care, provider gender, length of the primary care relationship, and site of care). A: The probability of “daily” or “almost daily” foot checks. B: The probability of “always” taking diabetes medications as prescribed. C: The probability of “always” following a recommended diet. D: The probability of “daily” exercise.