Chronic Disease

Primary care organizational characteristics are linked to the self-management behaviors of patients with diabetes

Patients with type 2 diabetes need to engage in certain self-management behaviors to control their blood glucose level. For example, they must regularly check their blood glucose level, follow a diabetes diet, consistently exercise, and take prescribed diabetes medications. In a study of how primary care organizational aspects of the Chronic Care Model (CCM) affect the self-management behaviors of patients with type 2 diabetes, Amer A. Kaissi, Ph.D., of Trinity University, and Michael Parchman, M.D., M.P.H., of the University of Texas, found mixed results.

The Chronic Care Model delineates six important organizational aspects of primary care necessary for optimizing outcomes from chronic disease care. These are: organizational support (commitment to patient self-management); community linkages, for example, to diabetes specialists and educators; decision support systems; self-management support (assessment of patients' needs and activities); delivery system design; and clinical information systems, such as diabetes registries, provider reminders, and feedback to the care team.

Nearly 26 percent of patients reported maintaining all four self-management behaviors in the last 6 months. Less than half reported adhering to diet (46 percent) and exercise (45 percent), 61 percent reported adhering to self-monitoring of blood glucose, and 85 percent reported adhering to their medications. Some primary care organizational features had a positive impact and others had a negative impact on patient self-management behaviors. For example, self-management support was positively associated, but community linkages were negatively associated with medication adherence.

In addition, decision support systems were positively associated with exercise and all four self-management behaviors, but clinical information systems were negatively associated with diet and all four self-management behaviors. Due to the small size of the clinics studied, physicians may have been preoccupied with the diagnosis and management of diabetes and its associated disorders, and may not have had sufficient time to educate their patients, suggest the study authors. They studied 617 patients with type 2 diabetes in 20 South Texas primary care clinics that ranged from solo physician clinics to county/city health clinics with 12 physicians. The study was supported by the Agency for Healthcare Research and Quality (HS13008).

See "Organizational factors associated with self-management behaviors in diabetes primary care clinics," by Drs. Kaissi and Parchman, in the September/October 2009 Diabetes Educator 35(5), pp. 843-850.

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