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Effective communication lacking in diabetes care

Primary care physicians providing diabetes care need to improve their communications with patients by offering more information specific to the patient’s experience, according to findings recently published in Annals of Family Medicine.

“Although the impact of diabetes is largely a function of both social determinants of health and genetic predisposition, an important determinant of outcome in primary care settings is the effectiveness of the consultation between patients and health care professionals,” Anthony Dowell, MBChB, of the department of primary health care and general practice at the University of Otago in New Zealand, and colleagues wrote. “There is little existing research directly observing the patient journey and interactions with different health professionals from the onset of diabetes.”

Researchers watched interactions between 32 patients newly diagnosed with diabetes and their health care providers via video for 6 months. The discussions were analyzed sequentially, linguistically, and for their broader ethnographic descriptions of diabetes care and its communication patterns and systems. They also evaluated the important decision points for both productive communication and the relationship to clinical outcome.

Dowell and colleagues found that six themes dominated these conversations: prior diabetes knowledge, duplication of information, care coordination, social context, consultation structure and evolution of self-management. The cumulative time spent on individual patient visits to health professionals ranged between 27 minutes and 7 hours, 12 minutes and the number of consultations per patient varied from one to 12. Physician consultations lasted for a median of 22 minutes (range, 6-56 minutes), nurse consultations a median of 41 minutes (range, 8-95 minutes), and dietitian consultations a median of 24 minutes (range, 17-52 minutes).

“Although clinicians showed high levels of technical knowledge and general communication skill, initial consultations were often driven by biomedical explanations out of context from patient experience. There was a perception of time pressure, but considerable time was spent with patients by health professionals repeating information that may not be relevant to patient need. Health professionals had little knowledge of what disciplines other than their own do and how their contributions to patient care may differ,” researchers wrote.

“Our results highlight the important role that communication plays in diabetes management, and the overall commitment of primary care teams to delivering patient care,” Dowell and colleagues wrote.

Though the study was conducted in New Zealand, its findings should be applicable in most countries, researchers added. – by Janel Miller