The patient-provider relationship: Attachment theory and adherence to treatment in diabetes
The patient-provider relationship: Attachment theory and adherence to treatment in diabetes
复制标题
DOI：
10.1176/appi.ajp.158.1.29
复制
发表时间：
2001-01-01
影响因子：
17.7
通讯作者：
Walker, EA
中科院分区：
文献类型：
--
作者：
Ciechanowski, PS;Katon, WJ;Walker, EA
目的：缺乏对糖尿病自我管理方案的坚持与糖尿病并发症的高风险相关。先前的研究表明，患者-提供者关系的质量与坚持糖尿病治疗有关。本研究试图通过依恋理论的概念模型，提高对糖尿病患者不坚持治疗的患者和提供者因素的理解。方法：使用依恋、治疗依从性、抑郁、糖尿病严重程度、患者-提供者沟通以及人口统计学数据对367名健康维护组织初级保健环境中的1型和2型糖尿病患者进行评估。血糖控制、医疗合并症以及对药物和门诊预约的依从性是通过自动数据确定的。使用协方差分析来确定依恋类型和患者-提供者沟通质量是否与坚持治疗有关。结果：表现出摒弃依恋的患者的血糖控制显著低于全神贯注或安全依恋的患者。依恋和沟通质量之间的交互作用与糖化血红蛋白(Hb A(1c))水平显著相关。在拒绝依恋类型的患者中，患者与提供者之间的沟通差(平均值=8.50%，SD=1.55%)和沟通良好(平均值=7.49%，SD=1.33%)之间的糖化血红蛋白水平有显著差异。在所有服用口服降糖药物的患者中，对药物的依从性和血糖监测的依从性在表现为患者与提供者沟通不良的患者中显著较差。结论：在患者与提供者沟通不佳的情况下，对依恋的排斥与糖尿病患者的治疗依从性较差相关。
Objective: Lack of adherence to diabetic self-management regimens is associated with a high risk of diabetes complications. Previous research has shown that the quality of the patient-provider relationship is associated with adherence to diabetes treatment. This study attempts to improve understanding of both patient and provider factors involved in lack of adherence to treatment in diabetic patients by using the conceptual model of attachment theory.Method: Instruments that assessed attachment, treatment adherence, depression, diabetes severity, patient-provider communication, and demographic data were administered to 367 patients with type 1 and 2 diabetes in a health maintenance organization primary care setting. Glucose control, medical comorbidity, and adherence to medications and clinic appointments were determined from automated data. Analyses of covariance were used to determine if attachment style and quality of patient-provider communication were associated with adherence to treatment.Results: Patients who exhibited dismissing attachment had significantly worse glucose control than patients with preoccupied or secure attachment. An interaction between attachment and communication quality was significantly associated with glycosylated hemoglobin (Hb A(1c)) levels. Among the patients with a dismissing attachment style, there was a significant difference in glycosylated hemoglobin levels between those who rated their patient-provider communication as poor (mean = 8.50%, SD = 1.55%) and those who rated this communication as good (mean = 7.49%, SD = 1.33%). Among all patients who were taking oral hypoglycemics, adherence to medications and glucose monitoring was significantly worse in patients who exhibited dismissing attachment and rated their patient-provider communication as poor.Conclusions: Dismissing attachment in the setting of poor patient-provider communication is associated with poorer treatment adherence in patients with diabetes.