Preferences for self-management support: Findings from a survey of diabetes patients in safety-net health systems
Preferences for self-management support: Findings from a survey of diabetes patients in safety-net health systems
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DOI：
10.1016/j.pec.2007.09.008
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发表时间：
2008-01-01
影响因子：
3.5
通讯作者：
Schillinger, Dean
中科院分区：
文献类型：
--
作者：
Sarkar, Urmimala;Piette, John D.;Schillinger, Dean
目的：我们试图确定在公立医院接受护理的糖尿病患者对不同模式的自我管理支持的兴趣，并评估人口统计学或疾病特异性因素是否与患者偏好相关。我们探讨了可能的作用，认为沟通需要在影响自我管理support.Methods的兴趣：电话调查的随机样本796英语和西班牙语的糖尿病患者（响应率47%）从四个城市的美国公立医院系统招募。在多变量模型中，我们测量了种族/民族，主要语言，自我报告的健康素养，自我效能感和糖尿病相关因素对患者对三种自我管理支持策略（电话支持，团体医疗访问和基于互联网的支持）的兴趣。我们探讨了在何种程度上，患者认为，更好地与供应商沟通，将提高他们的糖尿病控制，以及这种看法是否改变了患者因素和自我管理支持acceptance.Results之间的关系：百分之六十九的受访者表示有兴趣在电话支持，55%的团体医疗访问，和42%的互联网。与非西班牙裔白人相比，讲西班牙语的西班牙裔对电话支持（OR 3.45，95% CI 1.97-6.05）和团体医疗访视（OR 2.45，95% CI 1.49-4.02）更感兴趣，但对互联网自我管理支持（OR 0.56，95% CI 0.33-0.93）不太感兴趣。非裔美国人比白人更感兴趣的三个自我管理的支持策略。自我报告健康素养有限的患者比那些没有报告素养缺陷的患者更有可能对电话支持感兴趣。40%的人报告说，如果他们与医疗保健提供者更好地沟通，他们的糖尿病会得到更好的控制。这种感知的沟通益处与自我管理支持的兴趣独立相关（p < 0.001），但其纳入模型并没有改变患者特征和自我管理支持偏好之间的主要关联的强度。安全网环境中的许多糖尿病患者报告有兴趣接受自我管理支持，但提供自我管理支持的模式的偏好因种族/民族，语言能力和自我报告的健康literacy.Practice implications：公共卫生系统应考虑提供一系列的自我管理支持服务，以满足不同患者群体的需求。更广泛地传播和实施自我管理支持可能有助于解决这些环境中糖尿病患者之间更好的提供者沟通的未满足需求。(C)2007爱思唯尔爱尔兰有限公司保留所有权利。
Objective: We sought to identify interest in different modes of self-management support among diabetes patients cared for in public hospitals, and to assess whether demographic or disease-specific factors were associated with patient preferences. We explored the possible role of a perceived communication need in influencing interest in self-management support.Methods: Telephone survey of a random sample of 796 English and Spanish-speaking diabetes patients (response rate 47%) recruited from four urban US public hospital systems. In multilvariate models, we measured the association of race/ethnicity, primary language, self-reported health literacy, self-efficacy, and diabetes-related factors on patients' interest in three self-management support strategies (telephone support, group medical visits, and Internet-based support). We explored the extent to which patients believed that better communication with providers would improve their diabetes control, and whether this perception altered the relationship between patient factors and self-management support acceptance.Results: Sixty-nine percent of respondents reported interest in telephone support, 55% in group medical visits, and 42% in Internet. Compared to Non-Hispanic Whites, Spanish-speaking Hispanics were more interested in telephone support (OR 3.45, 95% CI 1.97-6.05) and group medical visits (OR 2.45, 95% CI 1.49-4.02), but less interested in Internet self-management support (OR 0.56, 95% CI 0.33-0.93). African-Americans were more interested than Whites in all three self-management support strategies. Patients with limited self-reported health literacy were more likely to be interested in telephone support than those not reporting literacy deficits. Forty percent reported that their diabetes would be better controlled if they communicated better with their health care provider. This perceived communication benefit was independently associated with interest in self-management support (p < 0.001), but its inclusion in models did not alter the strengths of the main associations between patient characteristics and self-management support preferences.Conclusion: Many diabetes patients in safety-net settings report an interest in receiving self-management support, but preferences for modes of delivery of self-management support vary by race/ethnicity, language proficiency, and self-reported health literacy.Practice implications: Public health systems should consider offering a range of self-management support services to meet the needs of their diverse patient populations. More broad dissemination and implementation of self-management support may help address the unmet need for better provider communication among diabetes patients in these settings. (C) 2007 Elsevier Ireland Ltd. All rights reserved.