Sarkar Urmimala, Piette John D, Gonzales Ralph, Lessler Daniel, Chew Lisa D, Reilly Brendan, Johnson Jolene, Brunt Melanie, Huang Jennifer, Regenstein Marsha, Schillinger Dean
Department of Medicine, Division of General Internal Medicine, University of California, San Francisco, United States.
Patient Educ Couns. 2008 Jan;70(1):102-10. doi: 10.1016/j.pec.2007.09.008. Epub 2007 Nov 7.
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.
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 multivariate 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.
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.
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.
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.
我们试图确定公立医院中接受治疗的糖尿病患者对不同自我管理支持模式的兴趣，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。我们探讨了感知到的沟通需求在影响自我管理支持兴趣方面可能发挥的作用。
对从美国四个城市公立医院系统招募的796名讲英语和西班牙语的糖尿病患者进行随机抽样电话调查（回复率47%）。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、自我效能感以及糖尿病相关因素与患者对三种自我管理支持策略（电话支持、小组医疗就诊和基于互联网的支持）兴趣之间的关联。我们探讨了患者认为与医护人员更好的沟通能改善其糖尿病控制的程度，以及这种认知是否改变了患者因素与自我管理支持接受度之间的关系。
69%的受访者表示对电话支持感兴趣，55%对小组医疗就诊感兴趣，42%对互联网支持感兴趣。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（比值比3.45，95%置信区间1.97 - 6.05）和小组医疗就诊（比值比2.45，95%置信区间1.49 - 4.02）更感兴趣，但对基于互联网的自我管理支持兴趣较低（比值比0.56，95%置信区间0.33 - 0.93）。非裔美国人对所有三种自我管理支持策略都比白人更感兴趣。自我报告健康素养有限的患者比未报告识字缺陷的患者更可能对电话支持感兴趣。40%的人表示，如果他们与医护人员沟通更好，他们的糖尿病会得到更好的控制。这种感知到的沟通益处与自我管理支持兴趣独立相关（p<0.001），但将其纳入模型并未改变患者特征与自我管理支持偏好之间主要关联的强度。
安全网环境中的许多糖尿病患者表示有兴趣接受自我管理支持，但自我管理支持的提供方式偏好因种族/民族、语言能力和自我报告的健康素养而异。
公共卫生系统应考虑提供一系列自我管理支持服务，以满足其多样化患者群体的需求。更广泛地传播和实施自我管理支持可能有助于满足这些环境中糖尿病患者对更好的医护人员沟通的未满足需求。
