Diabetes Mellitus, Hypertension
Conditions
Brief summary
The purpose of this research study is to assess patient and provider attitudes towards the role that patients should play in medical decision making and self-management. We will examine the degree to which similarity of attitudes held by VA patients being treated for co-morbid diabetes mellitus and hypertension and by their primary care providers is a determinant of patient satisfaction, patient adherence, and adequacy of blood pressure and diabetic control.
Detailed description
Previous work has shown that similarities in patients' and providers' beliefs about the role each should play in health care contexts are associated with greater patient satisfaction, greater trust in the provider, and greater treatment adherence. Extending this work by examining the effect of patient-provider attitudinal similarity on patients' diabetic and blood pressure control over an 18 month period is important because management of patients with co-morbid hypertension (HTN) and diabetes (DM) is a costly and clinically challenging task within the VA health system. Self-report questionnaires will be used to assess VA providers' beliefs about their own preferences for patient-provider role orientation in care, whereas interviews will be used to measure veterans' beliefs about their preferences for patient-provider role orientation in their care, satisfaction with their care, and self-reported treatment adherence. Data regarding health services use, prescription refills (a measure of adherence), and 18-month means of blood pressure and hemoglobin A1c will be collected from veterans' medical records. The study represents a critical step toward understanding how patient and provider attitudes toward care might be explicitly assessed and incorporated into the evidence-based health care delivery process to enhance the management of chronic illnesses and overall health among veterans.
Interventions
None listed
Sponsors
VA Office of Research and Development
Study design
Observational model
COHORT
Time perspective
RETROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
Patients enrolled in primary care clinics at the study sites (Iowa City VAMC, Jesse Brown VAMC - Chicago) who are scheduled to be seen by a participating provider in the next three (3) months and have been seen on at least three (3) additional occasions by that same provider in the prior 24 months. Participating patients must also: i) have prior diagnoses of both HTN and DM, as documented in VA administrative files; ii) have an active prescription for an anti-hypertensive medication in the following medication classes: thiazide diuretic, beta blocker, angiotensin converting enzyme (ACE) inhibitor, angiotensin receptor blocker (ARB), calcium channel blocker, or alpha blocker; iii) have an active prescription for an oral hypoglycemic agent or for an insulin preparation; iv) be able to provide informed consent; v) have a home telephone; and vi) reside in an independent living environment and not in a skilled care facility.
Exclusion criteria
i) cognitive impairment; ii) severe underlying illness, including: metastatic cancer, active treatment for any malignancy (excluding basal and squamous cell skin cancers), end-stage renal disease, cirrhosis, severe chronic obstructive lung disease requiring home oxygen therapy, and congestive heart failure with a documented left ventricular ejection fraction of less than 35% or a prior echocardiogram denoting severe left ventricular dysfunction; and iii) visits in the prior 18 months to a VA endocrinology, cardiology, or nephrology clinic.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| PPOS scores | same day as appointment with provider | Patient-Practitioner Orientation Scale: degree of symmetry between patient and provider regarding patient-centeredness |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Blood pressure | Same day as appointment with provider | Blood pressure measured at time of provider visit |
| Hemoglobin A1c | Same day as appointment with provider | Hemoglobin A1c, to assess glycemic control |
Countries
United States
Outcome results
None listed