Background: Type 2 Diabetes Mellitus is a growing health problem worldwide that places patients at increased risk of morbidity and mortality from microvascular and macrovascular complications. Research suggests that a patient-centered approach which focuses on patient-physician communication and collaboration in the management of chronic diseases such as diabetes may improve clinical outcomes in a glycemic parameter such as HbA1c. We measured the degree of this patient-centered approach in a sample population of subjects with Type 2 Diabetes in Jamaica with the use of the Patient Assessment of Care for Chronic Illness (PACIC) questionnaire and assessed the relationship between patient-centered care and glycemic control.
Purpose: To compare PACIC scores to hemoglobin A1C values in subjects with Type 2 Diabetes and to determine the correlation between patient-physician collaboration and glycemic control.
Methods: Participants were selected from the Diabetes Clinic at the University Hospital of the West Indies in Kingston, Jamaica, in August 2011. A total of 40 patients were screened, but only 19 met eligibility requirements and agreed to participate in the study. Informed consent was obtained. The patients were assigned a study number and then self-administered the Patient Assessment of Care for Chronic Illness (PACIC) questionnaire in a private examination room. The PACIC is a validated instrument consisting of a total of 20 multiple choice questions. It measures five subjective categories: 1) Patient activation; 2) Delivery system design and decision support; 3) Goal setting; 4) Problem solving/contextual counseling; and 5) Follow-up/ coordination. Each category can be averaged individually with scores ranging from 1-5. The overall PACIC score measures patient-physician collaboration with a score ranging from a low of 1.0 to a high of 5.0. Additional study data was collected by one of the authors (PD) for both characterization of the study population and for analysis of potential confounders. These additional independent variables included: patient age, type of treatment (i.e., lifestyle modification), and years diagnosed with diabetes mellitus.
Results: There were 19 subjects who were eligible for study and completed the PACIC questionnaire. There were more women than men (78.9%, 15 women and 4 men). The age range was 33-78 years with a mean age of 55. The range for years diagnosed with diabetes was 0.03 – 32 years with a mean of 14 years. Eight of the subjects (42.1%) were on combination therapy with insulin and oral hypoglycemic agents. Hemoglobin A1c values ranged from 5.4% – 15.5% with a mean of 10.8%. The PACIC scores ranged from 1.85 – 4.80 with a mean of 3.15. No statistically significant correlations were found between PACIC scores and HbA1c (r=.184). HbA1c did not significantly correlate with patient age (r=-.408), nor with years diagnosed with diabetes (r=-.244). Further statistical analysis using non-parametric correlation coefficients to take small sample sizes into account did not reveal any significant relationship either.
Conclusion: There was no statistically significant trends between our main variables of the patient-physician collaboration (PACIC score) and glycemic control (HbA1c). Analysis of potential confounders also failed to elicit any correlations with HbA1c. The major limitation in this study is the small sample size. An important next step would be to repeat this study with a larger clinic sample
