|
|
|
Michael Parchman, M.D., M.P.H. |
|
Principal Investigator |
|
Dept of Family & Community Medicine,
UTHSC-San Antonio |
|
|
|
|
Teresa Albright |
|
Felix Aguirre |
|
Tony & Ronnie Cadena |
|
Leah Raye Mabry |
|
Tom Mueller |
|
John Nielsen |
|
Rosalie Pena |
|
Michael Ragsdale |
|
Sheri Talley |
|
|
|
|
Continuity of care with a provider a key
component of primary care |
|
Little is known about importance of continuity
for patients with type 2 diabetes |
|
Self-care activities: diet, exercise, glucose
monitoring, are fundamental in the management of DM. |
|
|
|
|
|
People move through “Stages of Change” for
self-care behaviors: |
|
Precontemplation |
|
Contemplation |
|
Preparation |
|
Action |
|
Maintenance |
|
Little is known about Stage of Change for
self-care activities for diabetes |
|
|
|
|
|
Do you always follow your diabetic diet in the
way that you were instructed? |
|
No, and I do not intend to
in the next 6 months [Precontemplation] |
|
No, but I plan to
in the next 6 months [Contemplation] |
|
No, but I plan to
in the next month [Preparation] |
|
Yes, I have been
but for less than 6 month [Action] |
|
Yes, I have been
for more than 6 months [Maintenance] |
|
|
|
|
Is Continuity of care associated with glucose
control? |
|
Is Continuity of care associated with Stage of
Change for diabetes self-care behaviors? |
|
If so, is the relationship between Continuity
and glucose mediated by Stage of Change? |
|
|
|
|
|
|
|
|
|
Patient surveys: |
|
20 per physician |
|
Continuity: physician visits last 12 months |
|
Stage of Change: 5-item questionnaire |
|
Diabetes control: glycosylated hemoglobin [hgb
a1C] |
|
Chart data: |
|
last 2 blood pressure measurements |
|
|
|
|
20 Consecutive patients with type 2 DM |
|
Nurse records most recent hgb a1C and last 2 BP
readings |
|
Patient completes survey, returns it to office
staff. |
|
Surveys mailed to TAFP R-Net Coordinator (Anna
Jenkins) |
|
|
|
|
|
9 practices, 118 surveys,
hgb a1c recorded: n=97 |
|
56.1% female |
|
mean age: 55.4 (std. dev’n: 12.7) |
|
race/ethnic background: |
|
Hispanic 50% |
|
Non-Hispanic, White 37.2% |
|
African American 11.5% |
|
|
|
|
|
|
|
Education: 76.6% finished high school |
|
Income: |
|
< $10,000: 25.9% |
|
> $30,000: 31.5% |
|
How long a patient of this: |
|
Doctor: 4.9 years |
|
Practice: 6.1 years |
|
Same doctor now as 12 months ago? |
|
77.7% Yes |
|
|
|
|
|
|
|
|
Usual Provider Continuity [UPC] =
visits to PCP/total visits in last 12 mos |
|
Mean 0.72 (std dev’n: 0.25) |
|
|
|
|
Is Continuity of care associated with glucose
control? |
|
|
|
|
|
|
Is Stage of Change associated with glucose
control? |
|
|
|
|
|
|
Is Continuity of care associated with Stage of
Change? |
|
|
|
|
|
|
|
|
Continuity of care was not associated with
glucose control in this study |
|
Patients with higher levels of continuity are
significantly more likely to be in maintenance stage for exercise |
|
Patients in maintenance stage of change for diet
and SMBG have significantly better glucose control |
|
|
|
|
10. Nobody, except our patients (and us) knows
what FP’s do. |
|
9. Sometimes, even our patients don’t know |
|
8. Often, even we don’t know |
|
7. Managed Care loves us, but for the wrong
reasons |
|
6. It’s hard to improve practice without
understanding it |
|
|
|
|
5. Because it’s fun! |
|
4. We need to know how to take care of the
“problems that most of the people have most of the time.” |
|
3. Practice should be based on science. |
|
2. Family Practice is the hardest science of
them all. |
|
1. Knowledge is power. |
|
|
|
|
|
Interested in Participating in Future Studies? |
|
Contact Anna Jenkins at the TAFP office in
Austin: |
|
512-329-8666 |
|
ajenkins@tafp.org |
|
www.tafp.org |
|
Notes