An Educational Intervention for Type 2 Diabetes Patients



Status:Completed
Conditions:Diabetes
Therapuetic Areas:Endocrinology
Healthy:No
Age Range:18 - Any
Updated:3/13/2019
Start Date:November 27, 2013
End Date:January 9, 2017

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A Randomized Trial of an Educational Intervention in Type 2 Diabetes Patients

Diabetes is common, it is expensive, and it is a chronic condition. Estimates put the
prevalence of diabetes at almost 20 percent in VA patients and the prevalence of diabetes in
the VA is higher among racial and ethnic minorities. Poorly controlled diabetes leads to a
number of complications including cardiovascular disease, blindness, amputation, and end
stage renal disease. Adherence to medication regimens (as well as lifestyle factors such as
diet and exercise) is important to achieve diabetes care goals. Adherence to recommended care
is related at least in part to effective communication in medical encounters. This project is
designed to test a video intervention to improve patients' communication behaviors. Doctors
will also receive a communication skills training program. The project will assess the impact
of the training programs on communication and outcomes. The study is designed to help make
patient care more patient-centered, which is one of the six aims for improvement in the
Institute Of Medicine report, Crossing the Quality Chasm and is a goal of VA transformation
efforts.

Background: Diabetes is estimated to affect up to 1 in 5 VA patients overall and up to 1 in 4
racial/ethnic minority patients. Patients with low health literacy and minority groups have
more difficulty communicating with physicians, report lower adherence to physicians'
recommendations, and have higher rates of poor diabetes outcomes. Activating patients to use
more effective communication with physicians' can lead to better adherence to treatment and
to better biomedical outcomes. In this project the investigators build upon their prior work
from two Health Services Research & Development (HSRD) funded pilot projects to improve
doctor patient communication in patients with type 2 diabetes mellitus (T2DM). In a
previously funded short-term project, #SHP-08-182, the investigators conducted focus groups
with patients with T2DM to elicit and understand from the patient perspective, barriers to
communicating with their physician. This qualitative work was used in a subsequent pilot
project, #PPO-08-402 to refine and pilot test an educational video to encourage patients to
use active participatory communication in their visits to physicians. This work was
successfully completed and the product is a 10 minute video that in testing was found to be
acceptable to patients and feasible for patients to view immediately preceding their medical
encounter.

Objectives: In this project the investigators propose to test the effectiveness of the video
as an intervention to improved patients' communication. The primary aim is to conduct a
randomized controlled trial of an intervention testing whether the intervention increases
patients' active participatory communication behaviors, patients' post-visit ratings of self
efficacy to communicate, medication adherence, and diabetic control (HgbA1c). There are four
secondary aims which include assessments of the (1) mediators, and (2) moderators of the
relationship of the intervention condition to outcomes, (3) costs of the intervention, and
(4) an evaluation of the feasibility of using the video for pre-visit preparation.

Methods: The investigators will conduct a two group, pre-post, randomized controlled,
single-site trial of the intervention in patients with T2DM. The investigators will recruit
156 patients and their physicians for a pre and post-intervention visit. Physicians will be
trained with the agenda setting module from the Four Habits model. Patients will be
randomized to view a 10 minute intervention or control video prior to their second visit.
Visits will be audio recorded and analyzed for patients' and physicians' communication
behaviors. Self-efficacy to communicate will be collected by self report. Adherence will be
collected by self-report and by medication possession ratio. Diabetic control is collected by
chart review. Analyses will evaluate the relationship of the intervention condition to
outcomes, mediators and moderators of that relationship, and will estimate costs of the
intervention and feasibility of using the video in a busy clinic.

Impacts: VA transformation efforts including interprofessional Patient Aligned Care Teams
(PACT) are focusing attention on patient-centered care. Improved communication is a central
feature of patient centered care. Communication in medical interactions is critical and plays
an important, but often overlooked role in health-care decision making and quality of care.
Patients who have difficulty communicating are less involved in consultations with their
physician, receive less information and support, and are less satisfied with their care. In
turn, these patients may not understand their treatment options, may have less knowledge,
less positive beliefs about treatment and less trust in physician, and may experience poorer
health outcomes. Teaching patients to communicate more effectively is patient-centered
because it inherently supports a patient-driven approach to delivering healthcare. The
investigators' intervention is designed to encourage patients' active communication.
Improving patients' communication is a unique focus that may supplement and add to the VA
efforts in areas such as the Patient Aligned Care Team. In addition, the methodology is not
disease specific and may be a paradigm for improvement in other conditions.

Inclusion Criteria:

- Diagnosis of type 2 diabetes mellitus

- Hemoglobin A1c (HgbA1c) greater than or equal to 8

- Adults, age 18 or older

Exclusion Criteria:

- Lives in skilled nursing facility

- Dementia (abnormal score on Mini-COG)

- Terminal medical condition

- Drug- (e.g., steroid) induced diabetes.

- Blind or deaf (e.g., unable to view/hear video)
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Chicago, Illinois 60612
Phone: 312-569-6343
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