Patient-provider communication about diabetes self-care activities.

BACKGROUND AND OBJECTIVES

Controlling diabetes requires sustained self-management on the part of patients. Health care providers can support patients' self-care efforts through communication and problem solving. We conducted this study to determine the frequency with which self-care activities were discussed during office visits for follow-up care of diabetes and how much time was spent on these discussions.

METHODS

Audio recordings of 28 patient encounters in five primary care clinics were analyzed. We determined the frequency of self-care discussions and the amount of time devoted to these discussions.

RESULTS

Self-care was discussed in all 28 encounters. Median encounter times for each clinic ranged from 19.8 to 37.6 minutes, with self-care discussions taking from 0.1 to 17.2 minutes. Median discussion time devoted to all self-care activities was 5.2 minutes, representing 23.5% of a visit of median length. Blood sugar testing was discussed longer than the other activities. The least time was devoted to eye and foot examinations. Discussions were usually initiated by providers and did not differ in length according to who initiated the discussion.

CONCLUSIONS

Patients with diabetes regularly discussed self-care activities during follow-up visits at family medicine clinics. Providers varied in their capacity to incorporate self-care planning into routine medical care for patients with diabetes. Interventions are needed that help improve goal-setting and documentation. Documentation of self-care discussions will be important for meeting Meaningful Use criteria.