@article {7178, title = {Does physician communication influence older patients{\textquoteright} diabetes self-management and glycemic control? Results from the Health and Retirement Study (HRS).}, journal = {J Gerontol A Biol Sci Med Sci}, volume = {62}, year = {2007}, month = {2007 Dec}, pages = {1435-42}, publisher = {62A}, abstract = {

BACKGROUND: Effective chronic disease self-management among older adults is crucial for improved clinical outcomes. We assessed the relative importance of two dimensions of physician communication-provision of information (PCOM) and participatory decision-making (PDM)-for older patients{\textquoteright} diabetes self-management and glycemic control.

METHODS: We conducted a national cross-sectional survey among 1588 older community-dwelling adults with diabetes (response rate: 81\%). Independent associations were examined between patients{\textquoteright} ratings of their physician{\textquoteright}s PCOM and PDM with patients{\textquoteright} reported diabetes self-management (medication adherence, diet, exercise, blood glucose monitoring, and foot care), adjusting for patient sociodemographics, illness severity, and comorbidities. Among respondents for whom hemoglobin A1c (HbA1c) values were available (n=1233), the relationship was assessed between patient self-management and HbA1c values.

RESULTS: In separate multivariate regressions, PCOM and PDM were each associated with overall diabetes self-management (p<.001) and with all self-management domains (p<.001 in all models), with the exception of PDM not being associated with medication adherence. In models with both PCOM and PDM, PCOM alone predicted medication adherence (p=.001) and foot care (p=.002). PDM alone was associated with exercise and blood glucose monitoring (both p<.001) and was a stronger independent predictor than PCOM of diet. Better patient ratings of their diabetes self-management were associated with lower HbA1c values (B= -.10, p=.005).

CONCLUSION: Among these older adults, both their diabetes providers{\textquoteright} provision of information and efforts to actively involve them in treatment decision-making were associated with better overall diabetes self-management. Involving older patients in setting chronic disease goals and decision-making, however, appears to be especially important for self-care areas that demand more behaviorally complex lifestyle adjustments such as exercise, diet, and blood glucose monitoring.

}, keywords = {Aged, Blood Glucose, Communication, Cross-Sectional Studies, Diabetes Mellitus, Female, Glycated Hemoglobin, Humans, Male, Multivariate Analysis, Physician-Patient Relations, Self Care}, issn = {1079-5006}, doi = {10.1093/gerona/62.12.1435}, author = {Michele M Heisler and Cole, Ian and David R Weir and Eve A Kerr and Rodney A. Hayward} }