Teach-back method improves interactions between physicians, patients with diabetes
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Among patients with diabetes, the teach-back method was associated with better interactions with health care providers, more engagement in shared decision-making and a greater likelihood of receiving lifestyle advice, data show.
This, in turn, was associated with reductions in diabetes-related complications and hospitalizations, according to researchers.
The teach-back method is a communication technique in which patients are asked to state medical directions in their own words. The Agency for Healthcare Research and Quality (AHRQ) stated on its website that 80% of what is discussed between physicians and patients is “immediately forgotten by patients.” In addition, there is only a 50/50 likelihood that what the patient is told is recalled accurately. The AHRQ said these data make the teach-back method “important” to implement in practice.
Although the teach-back method has been “around for decades, there is a paucity of literature on how it is adopted, utilized and operates in a routine care setting (eg, primary care),” Young-Rock Hong, PhD, MPH, an assistant professor in the health services research, management and policy program at the University of Florida, told Healio.
“Previous studies have established its concept and effects on diabetes care outcomes and preventable hospitalization,” he said. “However, there was no known study (to our knowledge) to further examine how the teach‐back [method] operates in patient‐provider communication and subsequent health outcomes.”
The researchers analyzed outcomes among 2,901 U.S. adults who had diabetes without complications (median age, 61 years; 59.5% non-Hispanic white; 52.6% women). Of those patients, 25% indicated the teach-back method had been utilized during an office visit, which served as the study’s baseline. During the follow-up year, 16.8% of the teach-back method recipients experienced diabetes-related complications and 6.5% were admitted to a hospital at least once. The researchers used a pathway model analysis to interpret the results.
Hong and colleagues reported in the Journal of Primary Care & Community Health that utilizing teach-back with patients had a direct negative effect on hospitalization ( = –.127; P = .021) and indirect negative effects through lifestyle advice ( = –.012, P = .045) and diabetic complication ( = – .029, P = .049).
“This indirect effect shows us how teach‐back communication interplays with other components of patient care,” Hong said. “Teach-back is found to act effectively in patient‐provider communication and diabetes care management.”
According to the researchers, the teach-back method also had a direct positive association on the quality of the interaction that patients had with their health care provider ( = .474, P < .001), the utilization of shared decision-making ( = .058, P = .032) and the patient’s receipt of lifestyle advice ( = .094, P = .001).
In addition, the impact of the teach-back method on patients’ confidence in self-care management was “fully mediated by interaction quality and shared decision-making (total indirect; = .056, P = .001),” the researchers wrote. This suggested that the teach-back method positively impacted the patients’ confidence in taking care of themselves through active patient-provider interactions, Hong and colleagues added. However, use of the teach-back method resulted in “no significant path” of the patients’ confidence regarding diabetes-related complications or hospitalizations.
The study results should encourage all health care professionals to “invest more and promote more adoption and effective use of this almost zero‐cost and simple intervention,” Hong said.
He added that health care professionals can visit the websites of the American Academy of Family Physicians and AHRQ for strategies to implement the teach-back method. Such techniques, according to a Family Practice Management article, can include asking a patient, “Just to be sure I was clear, how will you take your new medicine?”
Although the time needed to implement the teach-back method has been seen as a barrier to its implementation, Hong said that anecdotal evidence suggests it should take physicians “less than 2 to 3 minutes” to employ it with patients.
References:
Bodenheumer T. Fam Pract Manag. 2018;25(4):20-22.
Guide to improving patient safety in primary care settings by engaging patients and families. https://www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-family-engagement/pfeprimarycare/teach-back-slides-final508.pdf. Accessed Jan. 26, 2022.
Hong Y-R, et al. J Prim Care Community Health. 2022;doi:10.1177/21501319211066658.
Perspective
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Kevin M. Pantalone, DO, ECNU, FACE
The teach-back method is a great strategy for helping one control their diabetes. The information conveyed to the patient at appointments is tremendous and overwhelming to many. In order to ensure they understand the information being conveyed, having them repeat back the information is a useful tool, so that provider and patient are on the same page.
I use the teach-back method on an individualized basis, particularly where a lot of information is being conveyed and the patient has attended the appointment alone. It is not required for all patient encounters. Additional strategies include writing down all the instructions for new medications and the plan of care, and then reviewing it line by line at the end of the appointment. It is also very valuable to have a spouse, or other caregiver, attend the appointment. Identifying a communication strategy that works with each patient is very important. There is no “one size fits all” approach. Regardless of the method, or combination of methods, ensuring the patient understands the plan of care is critical, not only for improved outcomes, but also patient safety.
It is very important during patient-physician communications to recognize that type 2 diabetes is a progressive disease and that patients will require additional therapies over time, even if many are doing what they have been instructed to do. It is important to have this discussion with patients so that they do not feel like a failure every time a new medication is added to their regimen or additional blood sugar testing is recommended. It is also very important to recognize the burden of management that patients with diabetes have to deal with, particularly those who require multiple injections of insulin per day, and thus, numerous blood sugar checks. Acknowledging and empathizing with the patients is extremely important and will considerably strengthen the provider-patient relationship and improve communication.
Staff endocrinologist
Endocrinology and Metabolism Institute
Cleveland Clinic
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