Implementation of a structured diabetes consultation model to facilitate a person-centered Approach: Results from a nationwide Dutch study
Rutten, Guy E.H.M.; Vugt, Heidi A.Van; Weerdt, Ingede; Koning, Eelcode
(2018) Diabetes Care, volume 41, issue 4, pp. 688 - 695
(Article)
Abstract
OBJECTIVE We assessed both from a patient and provider perspective the usefulness and added value of a consultation model that facilitates person-centered diabetes care. RESEARCH DESIGN AND METHODS The model consists of 1) inventory of disease and patient-related factors; 2) setting personal goals; 3) choosing treatment; and 4) determination of
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required care. It was implemented in 47 general practices and 6 hospital outpatient clinics. Providerswere trained, and patients were recommended to prepare their visit. All filled out a questionnaire after every consultation. Differences between primary and secondary care practices and between physician-led and nurse-led consultationswere analyzed. RESULTS Seventy-four physicians and thirty-one nurses participated, reporting on 1,366 consultations with type 2 diabetes patients. AccorDing to providers, the model was applicable in 72.4% (nurses 79.3% vs. physicians 68.5%, P<0.001). Physicians more often had a consultation time <25 min (80.4% vs. 56.9%, P<0.001). AccorDing to providers, two of three patients spoke more than half of the consultation time (outpatient clinics 75.2% vs. general practices 66.6%, P = 0.002; nurses 73.2% vs. physicians 64.4%, P = 0.001). Providers stated that person-related factors often determined treatment goals. Almost all patients (94.4%) reported that they made shared decisions; they felt more involved than before (with physicians 45.1% vs. with nurses 33.6%, P < 0.001) and rated the consultation 8.6 of 10. After physician-led consultations, 52.5% reported that the consultation was better than before (nurse visit 33.7%, P<0.001). CONCLUSIONS A consultation model to facilitate person-centered care seems well applicable and results inmore patient involvement, incluDing shared decisionmaking, and is appreciated by a substantial number of patients.
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Keywords: Internal Medicine, Endocrinology, Diabetes and Metabolism, Advanced and Specialised Nursing
ISSN: 0149-5992
Publisher: American Diabetes Association Inc.
Note: Funding Information: physicians and nurses, and the people with type 2 diabetes from general practices and out-patient hospital clinics for participating in the study. The authors also thank Rebecca Stellato (Julius Center for Health Sciences and Primary Care, Department of Biostatistics and Research Support, University Medical Center Utrecht, Utrecht, the Netherlands) for her statistical support. Funding. This project is supported by a grant from the Innovation Fund of the Dutch Health Insurance Companies and a grant from the Diabetes Fund, the Netherlands. Duality of Interest. G.E.H.M.R. reports receiving grants from Sanofi and personal fees from Novo Nordisk outside the submitted work. No other potential conflicts of interest relevant to this article were reported. Authors Contributions. G.E.H.M.R. designed the study, developed the methodology, interpreted the results, and wrote the manuscript. H.A.v.V. designed the study, coordinated the field work, developed the methodology, analyzed the data, interpreted the results, and contributed to the writing of the manuscript. I.d.W. and E.d.K. designed the study, developed the methodology, interpreted the results, and reviewed the manuscript. H.A.v.V. is the guarantor of this work and, as such, had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Publisher Copyright: © 2018 by the American Diabetes Association.
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