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Care Coordination, Follow-Up May Boost Diabetes Care Outcomes

Patient engagement efforts should center on care coordination and follow-up care to improve care outcomes for patients with diabetes, recent research shows.

Patient engagement techniques, including care coordination and follow-up communication, can produce more positive outcomes for patients with diabetes, shows a recent study published in Diabetes Technology & Therapeutics.

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The research team, led by Joni S. Williams, MD, MPH, sought to determine the extent to which patient engagement can improve diabetes care by examining the relationship between patient-centered care and self-care, quality of life, and glycemic control in 615 patients.

The researchers aimed to measure patient self-care through improvements in medication adherence, diet, exercise patterns, blood glucose testing, and foot care. The team measured quality of life through a physical component summary and a mental component summary.

Overall, patient engagement was significantly correlated to all self-care measures excluding exercise habits, which displayed no statistically significant improvement. Glycemic control was negatively correlated with patient engagement, as was the physical component of quality of life.

According to the researchers, this shows that providers need to continuously improve their patient engagement efforts. Although patients did improve many of their self-care habits and felt more empowered, these results were not enough to improve overall wellness.

“Given the importance of self-care behaviors in maintaining glycemic control and limiting complications, these findings suggest a need for improved quality of care and focused patient-centered efforts in patients with specific risk profiles,” the researchers explained.

These findings may not indicate that patient-centered care is ineffective in improving care outcomes; instead, the researchers asserted, they may show that perhaps stronger efforts are necessary to improve diabetic patient health.

“While more [patient-centered care] influences self-care behaviors, it does not have enough of an impact to result in sustained behavior change and, thus, improved glycemic control,” Williams and colleagues wrote.

Patient-centered care has the potential to make those sustained behavior changes, the researchers maintained. Providers may want to expand their efforts, practicing better care coordination between different physicians and offering out-of-office support for patients.

“As healthcare systems are being redesigned to be more patient centric, it is important to ensure that all aspects address these needs, rather than simply one part of the medical care process,” the researchers suggested.

“For example, systems that support patient autonomy, engaging and coordinating care with providers, and the ability to gather and use feedback, may be just as important as a patient-centered primary care visit.”

These findings also prompt further research for Williams and colleagues. While mental quality of life improved, the physical components did not. This suggests an interesting dichotomy that may be important for better understanding patient empowerment, the team said.

“Our findings suggest that while patients may benefit mentally from feeling empowered and participating in their own treatment processes, they may, in fact, feel overwhelmed, not be entirely capable of performing the tasks to meet provider expectations, or may even choose against the most effective treatment recommended by their care providers causing their physical QOL and overall health to be negatively impacted,” the team explained.

While the researchers were not sure why this split occurs, they noted that further research into the relationship could help providers improve their engagement efforts.

Going forward, however, providers may want to consider more expansive approach to patient-centered care. While boosting patient empowerment may have had a positive effect on improving patient self-care efforts, reaching the patient in other areas of their healthcare may be helpful in improving measurable outcomes measures, such as glycemic control in the case of diabetic patients.

“These findings suggest that PCC is an important factor in diabetes self-management, but may need to expand throughout the healthcare system before changes in outcomes such as glycemic control are noted,” the researchers concluded.

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