INTRODUCTION: The primary care visit is an important opportunity to discuss and modify diabetes management. OBJECTIVE: To gain insight into doctor-patient communication during primary care visits among English and Spanish speaking patients with type 2 diabetes and suboptimal glycemic control (HbA1c > 7%). METHODS: We conducted a quantitative content analysis of audiotaped primary care visits in 2 patient cohorts. In Study 1 (31 English-speaking patients), we examined factors associated with management changes, and in Study 2 (20 Spanish-speaking patients and their Spanish-speaking providers), we examined the association of question asking with HbA1c control. This study was conducted between November 2017 and January 2020 across 8 primary care practices within Kaiser Permanente Northern California. RESULTS: In Study 1, the only factor significantly associated with a diabetes management change was patient identification of diabetes as a priority prior to the visit (91.7% had a management change vs 52.6% of patients who did not identify diabetes as a priority; p = 0.02). In Study 2, patients with poorer glycemic control (HbA1c ≥ 10.0) asked significantly fewer questions (3.4 ± 1.8 vs 10.7 ± 6.9 questions per 15 minutes; p = 0.004). Overall, despite receiving primary care from language-concordant providers, Spanish-speaking Study 2 patients asked fewer questions than English-speaking Study 1 patients (4.5 ± 2.9 vs 7.5 ± 3.7 questions per 15 minutes, respectively; p = 0.004). CONCLUSION: Our results highlight 2 potential strategies (preparing patients for their visits through identifying priorities and learning how to ask more questions during visits) for improving diabetes primary care.
INTRODUCTION: The primary care visit is an important opportunity to discuss and modify diabetes management. OBJECTIVE: To gain insight into doctor-patient communication during primary care visits among English and Spanish speaking patients with type 2 diabetes and suboptimal glycemic control (HbA1c > 7%). METHODS: We conducted a quantitative content analysis of audiotaped primary care visits in 2 patient cohorts. In Study 1 (31 English-speaking patients), we examined factors associated with management changes, and in Study 2 (20 Spanish-speaking patients and their Spanish-speaking providers), we examined the association of question asking with HbA1c control. This study was conducted between November 2017 and January 2020 across 8 primary care practices within Kaiser Permanente Northern California. RESULTS: In Study 1, the only factor significantly associated with a diabetes management change was patient identification of diabetes as a priority prior to the visit (91.7% had a management change vs 52.6% of patients who did not identify diabetes as a priority; p = 0.02). In Study 2, patients with poorer glycemic control (HbA1c ≥ 10.0) asked significantly fewer questions (3.4 ± 1.8 vs 10.7 ± 6.9 questions per 15 minutes; p = 0.004). Overall, despite receiving primary care from language-concordant providers, Spanish-speaking Study 2 patients asked fewer questions than English-speaking Study 1 patients (4.5 ± 2.9 vs 7.5 ± 3.7 questions per 15 minutes, respectively; p = 0.004). CONCLUSION: Our results highlight 2 potential strategies (preparing patients for their visits through identifying priorities and learning how to ask more questions during visits) for improving diabetes primary care.
Authors: Michelle T Vo; Connie S Uratsu; Karen R Estacio; Andrea Altschuler; Eileen Kim; Stacey E Alexeeff; Alyce S Adams; Julie A Schmittdiel; Michele Heisler; Richard W Grant Journal: J Gen Intern Med Date: 2019-02-11 Impact factor: 5.128
Authors: Melissa M Parker; Alicia Fernández; Howard H Moffet; Richard W Grant; Antonia Torreblanca; Andrew J Karter Journal: JAMA Intern Med Date: 2017-03-01 Impact factor: 21.873
Authors: Richard W Grant; Connie S Uratsu; Karen R Estacio; Andrea Altschuler; Eileen Kim; Bruce Fireman; Alyce S Adams; Julie A Schmittdiel; Michele Heisler Journal: Contemp Clin Trials Date: 2016-01-26 Impact factor: 2.226