When Do Patients and Their Physicians Agree on Diabetes Treatment Goals and Strategies, and What Difference Does it Make?

Successful management of a chronic illness such as diabetes goes beyond competent medical care, it requires teamwork on the part of both patients and physicians. Some evidence suggests, however, that patients and physicians often disagree on the nature and outcomes of their health conditions, as well as strategies for effective health management. The authors of this study explored three questions: (1) to what extent do patients with type 2 diabetes and their health care providers agree on treatment goals and strategies?; (2) are there factors that predict agreement?; and (3) is greater agreement associated with better diabetes self-management? They surveyed 127 diabetes patients and 50 physicians in a Veteran's Health Association (VA) academic medical center in Michigan. They asked patients about socio-demographic and clinical characteristics, self-management, confidence in treatment efficacy and their physicians' decision-making styles. They asked care providers about general diabetes care attitudes and practices. The data indicates that overall, agreement between patients and physicians was low regarding treatment goals as well as regarding treatment strategies, although the rate of agreement increases when the analysis takes into account certain factors, such as patient education levels and physician reports of discussing more content areas of diabetes self-care. They also found that patient-provider agreement on treatment goals and strategies was associated with higher patient self-management and assessments of their self-management. This study supports the hypothesis that improved patient-physician concordance on goals and strategies provides a vehicle for better communication that can lead to better outcomes.

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