The influence of literacy on patient-reported experiences of diabetes self-management support.

BACKGROUND: Variability in disease-related outcomes may relate to how patients experience self-management support in clinical settings. OBJECTIVES: The purpose of this study was to identify factors associated with experiences of self-management support during primary care encounters. METHODS: A cross-sectional survey was conducted of 208 patients seen in a multidisciplinary diabetes program in an academic medicine clinic. Multiple regression analysis was used to test associations between patient-rated experiences of self-management support (Patient Assessment of Chronic Illness Care) and race, gender, insurance status, literacy, duration of diabetes, and intensity of care management. RESULTS: The Patient Assessment of Chronic Illness Care ratings decreased with age (r = -.235, p = .001), were higher for women than for men (3.95 vs. 3.65, t = 2.612, p= .010), and were greater for those with more education (F= 3.927, p = .009) and greater literacy skills (t = 3.839, p< .001). The ratings did not vary between racial (t = -1.108, p = .269) or insurance (F = 1.045, p = .374) groups and were unaffected by the duration of diabetes (r= .052, p = .466) and the intensity of care management (F = 1.028, p = .360). In multivariate models, literacy was the only variable contributing significantly to variation in self-management support ratings. DISCUSSION: Even when considering the objective intensity of health services delivered, literacy was the sole variable contributing to differences in patient ratings of self-management support. Although conclusions are limited by the cross-sectional nature of this study, the results emphasize the need to consider literacy when developing and communicating treatment plans requiring self-management skills.

Use of patient flow analysis to improve patient visit efficiency by decreasing wait time in a primary care-based disease management programs for anticoagulation and chronic pain: a quality improvement study.

BACKGROUND: Patients with chronic conditions require frequent care visits. Problems can arise during several parts of the patient visit that decrease efficiency, making it difficult to effectively care for high volumes of patients. The purpose of the study is to test a method to improve patient visit efficiency. METHODS: We used Patient Flow Analysis to identify inefficiencies in the patient visit, suggest areas for improvement, and test the effectiveness of clinic interventions. RESULTS: At baseline, the mean visit time for 93 anticoagulation clinic patient visits was 84 minutes (+/- 50 minutes) and the mean visit time for 25 chronic pain clinic patient visits was 65 minutes (+/- 21 minutes). Based on these data, we identified specific areas of inefficiency and developed interventions to decrease the mean time of the patient visit. After interventions, follow-up data found the mean visit time was reduced to 59 minutes (+/-25 minutes) for the anticoagulation clinic, a time decrease of 25 minutes (t-test 39%; p < 0.001). Mean visit time for the chronic pain clinic was reduced to 43 minutes (+/- 14 minutes) a time decrease of 22 minutes (t-test 34 %; p < 0.001). CONCLUSION: Patient Flow Analysis is an effective technique to identify inefficiencies in the patient visit and efficiently collect patient flow data. Once inefficiencies are identified they can be improved through brief interventions.

Diabetes educators' knowledge, opinions and behaviors regarding periodontal disease and diabetes.

PURPOSE: The purpose of this study was to determine certified diabetes educators' (CDE) knowledge, behaviors and opinions about periodontal disease and diabetes. METHODS: A 33 item questionnaire was distributed to CDEs who provide counseling and education services to patients with diabetes. Questions were open and closed-ended and Likert-scale. A total of 298 CDEs participated in the survey. Descriptive statistics were utilized. RESULTS: Most (62%) agreed that CDEs need to collaborate with dental professionals in disease management and 84% indicated interest in an oral health component being added to their continuing education. Only 20% felt confident in providing an oral health screening to their patients, while 51% discussed oral health with their patients and 64% said they have referred a patient to a dentist within the past year. Most (79%) have not received formal oral health education. CONCLUSION: The findings indicate that CDEs are aware of and agree that there is a link between oral health and systemic health and that collaboration with the dental profession would be a positive outcome for their patients, as would oral health topics being added to their continuing education courses. By introducing inter-professional collaboration between dental professionals and CDEs, and adding an oral health component to CE courses, CDEs' ability to educate their patients regarding the oral/systemic link could improve.

North Carolina internists' and endocrinologists' knowledge, opinions, and behaviors regarding periodontal disease and diabetes: need and opportunity for interprofessional education.

The aim of this study was to determine the knowledge and practice behaviors of one state's internists and endocrinologists who treat patients with any type of diabetes. A thirty-five-item questionnaire was mailed to 1,000 internists and 115 endocrinologists in North Carolina. Questions were open and closed ended and Likert-scaled. Descriptive statistics and bivariate analysis were utilized. The response rate was 34 percent (N=378). The overall usable response rate was 23 percent (N=254). Over half of the respondents (66 percent) were males. Internists' and endocrinologists' knowledge about periodontal disease was high. The majority of the respondents agreed that physicians should be taught about periodontal disease (88 percent) and should be trained to screen for periodontal disease in their patients (78 percent). However, when asked if they are confident in providing an oral health screening for their patients, the responses were evenly distributed from strongly agree to strongly disagree. This study suggests that internists and endocrinologists have some knowledge about oral health and believe that there is a link between periodontal disease and diabetes mellitus; however, the majority do not have sufficient familiarity with the studies that link periodontal disease and diabetes mellitus. They agree with the idea of collaboration with dental professionals to reduce the number of patients at risk for developing periodontal disease. Perhaps the time is conducive to promote interprofessional education and collaboration between medical and dental health care providers to prepare for the future increase in patient and treatment needs.