Factors that influence the intended intensity of diabetes care in a person‐centred setting. Issue 7 (9th August 2019)

• Record Type: Journal Article
• Authors: van Vugt, H. A.; Heijmans, M. J. W. M.; de Koning, E. J. P.; Rutten, G. E. H. M.
• Is Part Of: Diabetic medicine. Volume 37:Issue 7(2020)
• Page Start: 1167
• Page End: 1175
• Publication Date: 2019-08-09
• Subjects: Diabetes -- Periodicals; 616.462
• DOI: 10.1111/dme.14072
• Languages: English
• ISSNs: 0742-3071

Abstract

Abstract: Aims: To assess the intended intensity of Type 2 diabetes care and the factors associated with that intensity of care after the annual monitoring visit in which a new person‐centred diabetes consultation model including shared decision making was used. Methods: We conducted an observational study in 1284 people from 47 general practices and six hospital outpatient clinics. Intensity of care (more, no/minimal change, less) was based on monitoring frequency and referral to other care providers. We used multivariable analyses to determine the factors that were independently associated with intensity of care. Care providers also reported three factors which, in their opinion, determined the intensity of care. Results: After the consultation, 22.8% of people chose more intensive care, 70.6% chose no/minimal change and 6.6% chose less intensive care. Whether care became more intensive vs not/minimally changed was associated with a high educational level (odds ratio 1.65, CI 1.07 to 2.53; P =0.023), concern about illness (odds ratio 1.08; CI 1.00 to 1.17; P =0.045), goal‐setting (odds ratio 6.53, CI 3.79 to 11.27; P <0.001), comorbidities (odds ratio 1.12, CI 1.00 to 1.24; P =0.041) and use of oral blood glucose lowering medication (odds ratio 0.59, CI 0.39 to 0.89; P =0.011). Less intensive care vs no/minimal change was associated with lower diabetes distress levels (odds ratio 0.87, CI 0.79 to 0.97; P =0.009). According to care providers, quality of life, lifestyle, person's preferences and motivation, glycaemic control, and self‐management possibilities most frequently determined the intended care. Conclusions: In person‐centred diabetes care, the intended intensity of care was associated with both disease‐ and person‐related factors. What's new?: Diabetes care organizations often state that a person's preferences, needs, values and self‐management possibilities should be taken into account by care providers. After implementation of a person‐centred diabetes consultation model, which included shared decision‐making, the intended diabetes care for the upcoming year was heterogeneous and was associated with not only disease‐ but also person‐related factors, such as educational level, concern about illness, goal‐setting and diabetes distress. Care providers should consider both disease‐ and person‐related factors when making shared decisions regarding the intensity of the diabetes care.