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Wednesday 26 February 2014

Older Patients with T2DM and Comorbidities Don't Feel Heard

Responses in focus groups point to a "disconnect" between patients with these conditions and their providers.... 

Prevalence of type 2 diabetes has increased drastically in recent years, and can be expected to increase even more in the future. Not only is diabetes the seventh leading cause of death in the U.S., but its management and complications make up 23% of current health care expenditures. Most adults with T2DM have at least one comorbid condition, and almost half of them have three or more. It is therefore important that we focus on the most effective management of each patient's diabetes to reduce their risk of complications and lower the economic cost of this disease.

Beverly, EA. et al. evaluated patients' perceived challenges with their providers when treating their many health conditions to see how patient-physician interactions could be improved to provide better care and improve health outcomes.

This study involved a total of 32 patients with T2DM and at least one other chronic health condition. All patients were ≥60 years old, diagnosed with T2DM at least 1 year previous, and also diagnosed with one or more additional chronic conditions. They were recruited via a university diabetes database and also through direct mailings and flyers in the community. The patients were divided into 8 focus groups of 2-6 patients each, from which data was collected through semi-structured group interviews. These interviews were centered on patients' experiences and opinions about their health care plans for their diabetes and comorbid conditions. During these interviews, patients were asked open-ended questions about their perceived challenges with managing type 2 diabetes among their other chronic conditions, how they coped with potentially interacting conditions, and whether they perceived some conditions as being more severe/important than others. A multidisciplinary team then analyzed the data by marking and categorizing key words, phrases and texts to identify codes that would describe the overriding themes.

The 6 most commonly reported chronic conditions reported among these patients were hypertension, arthritis, retinopathy, hypercholesterolemia, coronary artery disease, and neuropathy. The main theme found was that older patients felt their providers did not understand and/or appreciate the difficulties that they face every day living with and managing their diabetes and other health conditions. Patients reported a general unwillingness of their providers to treat their diabetes and comorbid conditions. Experiences of limited support and empathy from their providers were also reported. Some patients felt that their providers were insensitive to their remaining years of life particularly because of their older age. Many participants also felt that their preferences for care were not taken into account by their provider. Participants also reported feeling that their care was not addressed to their individual needs and medical history, and desired more tailored treatment regimens specific to their needs. Generally speaking, patients want to have more interaction with their providers so that they can discuss the difficulties they are experiencing and vocalize their preference of treatment.

The patient population in this study was extremely homogenous, as all the patients were white, highly educated, and community-dwelling. These patients also had good glycemic control, which may have affected some of their responses. Further research with a more heterogenous population with varying glycemic control would be more reflective of older adults' experiences with healthcare providers. The responses obtained from the patients in this study point to a "disconnect" between patients with these conditions and their providers. Recent qualitative studies with primary care physicians describe the conflict providers experience with balancing patient preferences for treatment and their professional opinion on the proper care for the patient, along with determining the risks and benefits of following treatment guidelines. Future research should aim to incorporate data from physician-patient pairs to assess communication properly from both sides. Effective patient-provider communication and shared decision-making have been shown to not only improve patient satisfaction, but also increase adherence to treatment plans and improve health outcomes.


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