Patient-Physician Interpersonal Processes of Care at the Time of Diabetes Treatment Intensification and Their Links to Patient Outcomes Publisher Pubmed



Peimani M^{1, 2} ; Garmaroudi G¹ ; Stewart AL^{3, 4} ; Yekaninejad M⁵ ; Shakibazadeh E¹ ; Nasliesfahani E²
Source: Patient Education and Counseling Published:2021

Abstract

Objective: To investigate how patient-physician interpersonal processes of care are related to levels of diabetes-related distress, diabetes medication-taking behavior, and HbA1c during conversations with patients about intensifying medication. Methods: We randomly recruited 1270 patients from diabetes specialty clinics in Tehran, Iran who were taking an additional oral diabetes medication or starting insulin during the prior 3 months. This interviewer-administered cross-sectional survey assessed multiple aspects of patient-physician interpersonal processes, diabetes-related distress, and diabetes medication-taking. Clinical history and HbA1c were collected from electronic medical records. Regression estimates and Structural Equation Modeling were used to test associations. Results: Some communication scales indicated a significant relationship with total diabetes distress (P < 0.001). Diabetes medication-taking was associated with less diabetes distress (adjusted odds ratio [aOR]=0.45, P < 0.001), lower Hurried Communication (aOR=0.72, P = 0.013), higher Elicited Concerns (aOR=1.30, P = 0.012), and higher Explained Results (aOR=1.41, P < 0.001) scores. SEM analyses showed medication-taking behavior was associated with a 0.68 decrease in HbA1c. Hurried Communication and diabetes distress were directly associated with HbA1c. Conclusion: Aspects of patient-physician interpersonal processes at the time of intensifying diabetes treatment may be related to experiencing less distress, effective medication-taking, and improved HbA1c. Practice implications: The results are intended to inform communication strategies that physicians might incorporate into practice. © 2021 Elsevier B.V.