title: When do patients and their physicians agree on diabetes treatment goals and strategies, and what difference does it make?
abstract: BACKGROUND
  For patients with chronic illnesses, it is hypothesized that effective patient-provider collaboration contributes to improved patient self-care by promoting greater agreement on patient-specific treatment goals and strategies. However, this hypothesis has not been tested in actual encounters of patients with their own physicians.
  
  
  OBJECTIVE
  To assess the extent to which patients with type 2 diabetes agree with their primary care providers (PCPs) on diabetes treatment goals and strategies, the factors that predict agreement, and whether greater agreement is associated with better patient self-management of diabetes.
  
  
  METHODS
  One hundred twenty-seven pairs of patients and their PCPs in two health systems were surveyed about their top 3 diabetes treatment goals (desired outcomes) and strategies to meet those goals. Using several measures to evaluate agreement, we explored whether patient characteristics, such as education and attitudes toward treatment, and patient-provider interaction styles, such as shared decision making, were associated with greater agreement on treatment goals and strategies. We then examined whether agreement was associated with higher patient assessments of their diabetes care self-efficacy and self-management.
  
  
  RESULTS
  Overall, agreement on top treatment goals and strategies was low (all kappa were less than 0.40). In multivariable analyses, however, patients with more education, greater belief in the efficacy of their diabetes treatment, and who shared in treatment decision making with their providers were more likely to agree with their providers on treatment goals or strategies. Similarly, physician reports of having discussed more content areas of diabetes self-care were associated with greater agreement on treatment strategies. In turn, greater agreement on treatment goals and strategies was associated both with higher patient diabetes care self-efficacy and assessments of their diabetes self-management.
  
  
  CONCLUSIONS
  Although patients and their PCPs in general had poor agreement on goals and strategies for managing diabetes, agreement was associated with higher patient self-efficacy and assessments of their diabetes self-management. This supports the hypothesis that enhancing patient-provider agreement on both overall treatment goals and specific strategies to meet these goals may lead to improved patient outcomes.
authors.affiliation: Veterans Affairs Center for Practice Management and Outcomes Research, VA Ann Arbor Healthcare System, Ann Arbor, MI 48113-0170, USA. mheisler@umich.edu
authors.forename: Michele
authors.initials: M
authors.lastname: Heisler
authors.forename: Sandeep
authors.initials: S
authors.lastname: Vijan
authors.forename: Robert M
authors.initials: RM
authors.lastname: Anderson
authors.forename: Peter A
authors.initials: PA
authors.lastname: Ubel
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Bernstein
authors.forename: Timothy P
authors.initials: TP
authors.lastname: Hofer
mesh_terms: D000328:Adult; D003924:Diabetes Mellitus, Type 2 / Q000628:therapy*; D005260:Female; D006040:Goals; D006801:Humans; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D010353:Patient Education as Topic / Q000379:methods; D010817:Physician-Patient Relations; D010821:Physicians, Family / Q000523:psychology*; D012648:Self Care; D020377:Self Efficacy; D016896:Treatment Outcome