TY - JOUR
T1 - Examining Variations in Action Plan Quality Among Adults With Type 2 Diabetes in Primary Care
AU - Kjaer, Pernille H
AU - Fisher, Lawrence
AU - Potter, Michael B
AU - Dedhia, Mansi
AU - Parra, José
AU - Ejskjaer, Niels
AU - Skovlund, Søren
AU - Hessler, Danielle
N1 - © Copyright 2021 by the American Board of Family Medicine.
PY - 2021/6/6
Y1 - 2021/6/6
N2 - INTRODUCTION: Collaborative goal setting and action-planning are key elements of self-management support for people with type 2 diabetes mellitus (T2DM), however little is known regarding action plan quality or correlation of quality in primary T2DM care.METHODS: T2DM patients from 12 primary care sites participated in either: Connection to Health (CTH; 6 practices), consisting of a health survey followed by collaborative action planning, or Enhanced Engagement CTH (EE-CTH; 6 practices), including additional training in relationship building promoting patient engagement. Action plan quality was rated using an adapted version of the Goal-Setting Evaluation Tool for Diabetes (GET-D) (dual coding of 20%, inter-rater reliability [IRR] >80%). Associations with patient characteristics were examined using generalized linear mixed models adjusting for clustering by clinic and intervention arm.RESULTS: With a mean score ± standard deviation (SD) of 14.62 ± 3.87 on a 0 to 20 scale (n = 725), overall action plan quality was moderate-high. Higher health literacy (β = 1.184, 95% CI, 0.326-2.041; P = .007), and having no social risks (β = 0.416; 95% CI, 0.062-0.770; P = .021) were associated with higher action plan quality, whereas sex, age, language, education level, depression, stress, and health distress were unrelated to quality (P value not significant). Higher quality was associated with greater patient confidence in the plan (β = 0.050; 95% CI, 0.016-0.084, P = .004).CONCLUSIONS: Although there was a considerable difference in action plan quality ratings, ratings did not systematically differ based on most patient demographic or mental health measures. Results suggest that action planning should be tailored to health literacy and social risks. Further research should examine associations between quality and longer-term clinical outcomes.
AB - INTRODUCTION: Collaborative goal setting and action-planning are key elements of self-management support for people with type 2 diabetes mellitus (T2DM), however little is known regarding action plan quality or correlation of quality in primary T2DM care.METHODS: T2DM patients from 12 primary care sites participated in either: Connection to Health (CTH; 6 practices), consisting of a health survey followed by collaborative action planning, or Enhanced Engagement CTH (EE-CTH; 6 practices), including additional training in relationship building promoting patient engagement. Action plan quality was rated using an adapted version of the Goal-Setting Evaluation Tool for Diabetes (GET-D) (dual coding of 20%, inter-rater reliability [IRR] >80%). Associations with patient characteristics were examined using generalized linear mixed models adjusting for clustering by clinic and intervention arm.RESULTS: With a mean score ± standard deviation (SD) of 14.62 ± 3.87 on a 0 to 20 scale (n = 725), overall action plan quality was moderate-high. Higher health literacy (β = 1.184, 95% CI, 0.326-2.041; P = .007), and having no social risks (β = 0.416; 95% CI, 0.062-0.770; P = .021) were associated with higher action plan quality, whereas sex, age, language, education level, depression, stress, and health distress were unrelated to quality (P value not significant). Higher quality was associated with greater patient confidence in the plan (β = 0.050; 95% CI, 0.016-0.084, P = .004).CONCLUSIONS: Although there was a considerable difference in action plan quality ratings, ratings did not systematically differ based on most patient demographic or mental health measures. Results suggest that action planning should be tailored to health literacy and social risks. Further research should examine associations between quality and longer-term clinical outcomes.
KW - Chronic Disease
KW - Disease Management
KW - Health Literacy
KW - Health Surveys
KW - Patient Participation
KW - Patient-Centered Care
KW - Patient-Reported Outcome Measures
KW - Primary Health Care
KW - Self-Management
KW - Type 2 Diabetes Mellitus
UR - http://www.scopus.com/inward/record.url?scp=85107811027&partnerID=8YFLogxK
U2 - 10.3122/jabfm.2021.03.200285
DO - 10.3122/jabfm.2021.03.200285
M3 - Journal article
C2 - 34088821
SN - 1557-2625
VL - 34
SP - 608
EP - 617
JO - Journal of the American Board of Family Medicine
JF - Journal of the American Board of Family Medicine
IS - 3
ER -