Title: Is Patient Readiness to Change a Predictor of Improved Glycemic Control
1Is Patient Readiness to Change a Predictor of
Improved Glycemic Control?
HealthPartners Research Foundation
- Patrick OConnor, MD, MPH
- Stephen E. Asche, MA
- A. Lauren Crain, PhD
- William A. Rush, PhD
- January 2004
Robin R. Whitebird, PhD Leif I. Solberg, MD JoAnn
M. Sperl-Hillen, MD
2Study Goal
- To test whether patient readiness to change (in
terms of diabetes self care) is related to
outcomes as measured by improvement in
hemoglobin A1c values
3Research Questions
- Do diabetes patients in higher stages of
readiness to change show greater improvement in
A1c levels than those in lower stages? - Are there subgroups of individuals for whom
higher readiness to change is associated with
more improvement in A1c levels? - What patient-level variables predict improvements
in A1c?
4Project Quest
- Multi-site 4 year study involving 19 medical
groups, 85 clinics, 700 providers and 7865
patients. - Designed to identify patient, physician, clinic
and other factors that predict quality of care
for adults with diabetes or heart disease - Funded by Agency for HealthCare Research and
Quality (AHRQ)
5Project Quest Diabetes Sample
- Diabetes patients in 1998 (based on ICD-9 and
pharmacy codes) - HealthPartners insurance in 1998
- 19 yrs old in 1998
- Returned patient survey
- Self-reported having diabetes
- Consented to chart audit
- (N2016)
6Data Sources
- Administrative data
- Diabetes determination (based on diagnosis
pharmacy codes), demographic information - Patient survey (2001)
- Readiness to change other measures
- Chart audit (2001 and 2002)
- A1c levels at baseline and 1 year follow-up
7Analysis Sample
8Readiness to Change Background
- Stages of change are part of Prochaska
DiClementis Transtheoretical Model - Model is applied to behavior change, often a
health-related behavior - Model has been applied in the areas of smoking
cessation, exercise, diet changes, weight
control, radon testing, drug abuse, medical
compliance - Few applications to changes in diabetes self care
9Readiness to Change Background
- Typical use Characterize people as to their
stage of change and then tailor interventions
that are effective for each stage to yield better
outcomes - In this analysis We examine the relationship
between diabetes self care readiness to change
and glycemic control (change in A1c), but ignore
any particular intervention received
Stages of change
10Defining readiness to change in terms of diabetes
self care
11Stage of change for diabetes self care
- For analysis we collapsed contemplation
preparation into 1 group
12Sample Characteristics (A1c gt7)
p lt .05 p lt .01 Sample A1c at baseline gt
7 and had stage classification
13Sample Characteristics (A1cgt7)
- p lt .05 p lt .01
- Sample A1c at baseline gt 7 and had stage
classification
14Sample Characteristics (A1cgt7)
- p lt .05 p lt .01
- Sample A1c at baseline gt 7 and had stage
classification
15One year improvement in A1c (for those with
baseline A1c gt7)
A1c improvement was significant (greater than
0) A1c improvement was not significantly
different by stage of change
16Predicting change in A1c from readiness to change
All ns
Preparers Contemplators (1) vs.
Precontemplators (0)
17Change in A1c by stage for those with and without
macrovascular problems
Significant stage of change by macrovascular
problem interaction (p.02) in linear regression
predicting delta A1c from stage of change,
macrovascular problems, age, sex, education,
duration of diabetes, recent DM med change,
medication compliance, belief in doctors advice
18Significant patient survey predictors of one year
improvement in A1c
p lt .05 p lt .01 Linear regression
controlling for age, sex, education, and duration
of diabetes
19Patient survey items that did not relate to
reduction in A1c from baseline to followup
Limited to those with A1c gt7 at baseline
20Conclusions
- Diabetes patients with A1c gt7 at baseline
showed a statistically significant improvement
(reduction) in A1c from the baseline to the
follow-up year - When looking at the entire sample of diabetes
patients with A1c gt7 at baseline, greater
readiness to change was not associated with
improvement in A1c one year later - However, for the 56 of patients without
macrovascular problems, greater readiness to
change was positively and significantly
associated with improvement in A1c
21Conclusions
- Improvement in A1c is significantly greater for
those who - 1) take medications as prescribed
- 2) have had a change to the type or dosage of
diabetes medication - 3) believe following doctors advice will delay
future eye, foot and kidney problems