title: Improving hypertension control in diabetes mellitus: the effects of collaborative and proactive health communication.
abstract: BACKGROUND
  Communication between patients and clinicians using collaborative goals and treatment plans may overcome barriers to achieving hypertension control in routine diabetes mellitus care. We assessed the interrelation of patient-clinician communication factors to determine their independent associations with hypertension control in diabetes care.
  
  
  RESULTS
  We identified 566 older adults with diabetes mellitus and hypertension at the DeBakey VA Medical Center in Houston, Tex. Clinical and pharmacy data were collected, and a patient questionnaire was sent to all participants. A total of 212 individuals returned surveys. Logistic regression analyses were performed to assess the effect of patient characteristics, self-management behaviors, and communication factors on hypertension control. Three communication factors had significant associations with hypertension control. Two factors, patients' endorsement of a shared decision-making style (odds ratio 1.61, 95% confidence interval 1.01 to 2.57) and proactive communication with one's clinician about abnormal results of blood pressure self-monitoring (odds ratio 1.89, 95% confidence interval 1.10 to 3.26), had direct, independent associations in multivariate regression. Path analysis was used to investigate the direct and indirect effects of communication factors and hypertension control. Decision-making style (beta=0.20, P<0.01) and proactive communication (beta=0.50, P<0.0001) again demonstrated direct effects on hypertension control. A third factor, clinicians' use of collaborative communication when setting treatment goals, had a total effect on hypertension control of 0.16 (P<0.05) through its direct effects on decision-making style (beta=0.28, P<0.001) and proactive communication (beta=0.22, P<0.01).
  
  
  CONCLUSIONS
  Three communication factors were found to have significant associations with hypertension control. Patient-clinician communication that facilitates collaborative blood pressure goals and patients' input related to the progress of treatment may improve rates of hypertension control in diabetes care independent of medication adherence.
authors.affiliation: Houston Center for Quality of Care and Utilization Studies, Michael E. DeBakey VA Medical Center (152), 2002 Holcombe Blvd, Houston, TX 77030, USA. anaik@bcm.tmc.edu
authors.forename: Aanand D
authors.initials: AD
authors.lastname: Naik
authors.forename: Michael A
authors.initials: MA
authors.lastname: Kallen
authors.forename: Annette
authors.initials: A
authors.lastname: Walder
authors.forename: Richard L
authors.initials: RL
authors.lastname: Street
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001291:Attitude of Health Personnel; D001294:Attitude to Health; D018660:Blood Pressure Monitoring, Ambulatory / Q000523:psychology; D003142:Communication; D015897:Comorbidity; D003299:Cooperative Behavior; D003657:Decision Making; D048909:Diabetes Complications / Q000188:drug therapy / Q000523:psychology / Q000628:therapy*; D019468:Disease Management; D005260:Female; D006040:Goals; D006801:Humans; D006949:Hyperlipidemias / Q000150:complications; D006973:Hypertension / Q000188:drug therapy / Q000523:psychology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D010353:Patient Education as Topic; D010817:Physician-Patient Relations; D011795:Surveys and Questionnaires
chemical_list: D000959:Antihypertensive Agents