title: Self-efficacy in diabetic care and occurrence of adverse events in an ambulatory setting.
abstract: OBJECTIVE
  To assess the relationship between patients' self-efficacy and the occurrence of adverse events in patients with insulin-using, type-2 diabetes mellitus in an ambulatory setting.
  
  
  METHODS
  A prospective cohort study. Patients' risks were estimated by relative risk (RR) and analyzed by Poisson regression using the generalized estimating equation (GEE).
  
  
  METHODS
  Diabetic clinic at a university-affiliated, tertiary-care hospital in Bangkok, Thailand.
  
  
  METHODS
  One hundred and fifty-seven patients in the low self-efficacy group and 153 patients in the high self-efficacy group based on their pre-test scores, including self-efficacy in problem-solving and daily living.
  
  
  METHODS
  Adverse events defined as unplanned incidents related to medical management in diabetic care, leading to patient harm. Patient data were followed up every 3 months for 1 year.
  
  
  RESULTS
  The incident rate of adverse events in the low self-efficacy group was 2.12 incidents per 100 person-months, in comparison with 0.44 incidents per 100 person-months in the high self-efficacy group, resulting in adjusted RR of 4.75 (95% confidence interval (CI): 2.19-10.28). The use of long-acting insulin was also found to increase the risk of adverse events by 3.11 times (95% CI: 1.35-7.18) without interaction with patients' self-efficacies.
  
  
  CONCLUSIONS
  To increase patients' self-efficacy by strengthening patient and family involvement may help prevent harmful events and improve patient safety in an ambulatory setting among chronically ill patients with type-2 diabetes mellitus.
authors.affiliation: Department of Preventive and Social Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand. sjiruth@gmail.com.
authors.forename: Benjamas
authors.initials: B
authors.lastname: Sirikamonsathian
authors.forename: Jiruth
authors.initials: J
authors.lastname: Sriratanaban
authors.forename: Narin
authors.initials: N
authors.lastname: Hiransuthikul
authors.forename: Somrat
authors.initials: S
authors.lastname: Lertmaharit
mesh_terms: D000553:Ambulatory Care / Q000523:psychology / Q000706:statistics & numerical data; D003924:Diabetes Mellitus, Type 2 / Q000523:psychology* / Q000628:therapy; D005260:Female; D006801:Humans; D008297:Male; D019300:Medical Errors / Q000523:psychology / Q000706:statistics & numerical data*; D008875:Middle Aged; D061214:Patient Safety; D016012:Poisson Distribution; D011446:Prospective Studies; D011581:Psychological Tests; D012306:Risk; D020377:Self Efficacy; D013785:Thailand / Q000453:epidemiology
keywords: adverse event; ambulatory setting; diabetic care; self-efficacy