Physician support for diabetes patients and clinical outcomes.
BACKGROUND
Physician practical support (e.g. setting goals, pro-active follow-up) and communicative support (e.g., empathic listening, eliciting preferences) have been hypothesized to influence diabetes outcomes.


METHODS
In a prospective observational study, patients rated physician communicative and practical support using a modified Health Care Climate Questionnaire. We assessed whether physicians' characteristic level of practical and communicative support (mean across patients) and each patients' deviation from their physician's mean level of support was associated with glycemic control outcomes. Glycosylated haemoglobin (HbA1c) levels were measured at baseline and at follow-up, about 2 years after baseline.


RESULTS
We analysed 3897 patients with diabetes treated in nine primary care clinics by 106 physicians in an integrated health plan in Western Washington, USA. Physicians' average level of practical support (based on patient ratings of their provider) was associated with significantly lower HbA1c at follow-up, controlling for baseline HbA1c (p = .0401). The percentage of patients with "optimal" and "poor" glycemic control differed significantly across different levels of practical support at follow (p = .022 and p = .028). Communicative support was not associated with differences in HbA1c at follow-up.


CONCLUSIONS
This observational study suggests that, in community practice settings, physician differences in practical support may influence glycemic control outcomes among patients with diabetes.
Institute for General Practice, University Hospital Jena, Jena, Germany. jochen.gensichen@med.uni-jena.de
Jochen
J
Gensichen
Michael
M
Von Korff
Carolyn M
CM
Rutter
Michelle D
MD
Seelig
Evette J
EJ
Ludman
Elizabeth Hb
EH
Lin
Paul
P
Ciechanowski
Bessie A
BA
Young
Edward H
EH
Wagner
Wayne J
WJ
Katon
D000368:Aged; D000369:Aged, 80 and over; D015190:Blood Glucose Self-Monitoring; D003920:Diabetes Mellitus / Q000628:therapy*; D005194:Family Practice; D005260:Female; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000032:analysis; D038321:Glycemic Index; D006801:Humans; D008297:Male; D017063:Outcome Assessment, Health Care; D010817:Physician-Patient Relations; D010818:Practice Patterns, Physicians' / Q000592:standards / Q000706:statistics & numerical data; D011787:Quality of Health Care; D012944:Social Support; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D014861:Washington
D006442:Glycated Hemoglobin