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Is Patient Readiness to Change a Predictor of Improved Glycemic Control

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Title: Is Patient Readiness to Change a Predictor of Improved Glycemic Control


1
Is 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
2
Study 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

3
Research 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?

4
Project 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)

5
Project 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)

6
Data 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

7
Analysis Sample
8
Readiness 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

9
Readiness 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
10
Defining readiness to change in terms of diabetes
self care

11
Stage of change for diabetes self care
  • For analysis we collapsed contemplation
    preparation into 1 group

12
Sample Characteristics (A1c gt7)
p lt .05 p lt .01 Sample A1c at baseline gt
7 and had stage classification
13
Sample Characteristics (A1cgt7)
  • p lt .05 p lt .01
  • Sample A1c at baseline gt 7 and had stage
    classification

14
Sample Characteristics (A1cgt7)
  • p lt .05 p lt .01
  • Sample A1c at baseline gt 7 and had stage
    classification

15
One 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
16
Predicting change in A1c from readiness to change
All ns
Preparers Contemplators (1) vs.
Precontemplators (0)
17
Change 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
18
Significant 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
19
Patient survey items that did not relate to
reduction in A1c from baseline to followup
Limited to those with A1c gt7 at baseline
20
Conclusions
  • 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

21
Conclusions
  • 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
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