%0 Journal Article %J J Gerontol A Biol Sci Med Sci %D 2007 %T Does physician communication influence older patients' diabetes self-management and glycemic control? Results from the Health and Retirement Study (HRS). %A Michele M Heisler %A Cole, Ian %A David R Weir %A Eve A Kerr %A Rodney A. Hayward %K Aged %K Blood Glucose %K Communication %K Cross-Sectional Studies %K Diabetes Mellitus %K Female %K Glycated Hemoglobin %K Humans %K Male %K Multivariate Analysis %K Physician-Patient Relations %K Self Care %X

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' 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' ratings of their physician's PCOM and PDM with patients' 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' 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.

%B J Gerontol A Biol Sci Med Sci %I 62A %V 62 %P 1435-42 %8 2007 Dec %G eng %N 12 %L newpubs2008_Heisler_etal.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/18166697?dopt=Abstract %4 aging/Chronic Illness/diabetes %$ 18740 %R 10.1093/gerona/62.12.1435