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Sharing personalised clinical information with diabetes patients prior to their consultation: results of a pilot study

Sharing personalised clinical information with diabetes patients prior to their consultation: results of a pilot study and future work. Presented by Dr Máire O’ Donnell on behalf of Dr YY Hong, Dr YY Lim, Dr SY Lim and Dr SF Dinneen Diabetes Centre, University Hospital Galway

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Sharing personalised clinical information with diabetes patients prior to their consultation: results of a pilot study

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  1. Sharing personalised clinical information with diabetes patients prior to their consultation: results of a pilot study and future work Presented by Dr Máire O’ Donnell on behalf of Dr YY Hong, Dr YY Lim, Dr SY Lim and Dr SF Dinneen Diabetes Centre, University Hospital Galway Department of Medicine, NUIG

  2. Outline of talk • Present results from pilot study conducted in 2007 • Outline some thoughts on how we can progress this work

  3. Background (1) • Patient centredness • Patient involvement in decisions about their health care • Consideration of individual patient preferences and circumstances Mead N, Bower P. Patient Educ Counselling 2002;48:51-61

  4. Background (2) • Patient centredness and chronic diseases • Diabetes requires active patient involvement in self management for improved clinical outcomes • Effective communication during the clinical consultation essential in enabling the patient to self manage

  5. Person with diabetes Diamond Primary Care Specialist care

  6. Aim To measure the impact of sharing personalised clinical information in written format with patients on the clinical consultation

  7. Intervention • Already in Use: Diamond-generated proforma (for doctors) • New: A Clinical Information Sheet was developed (for patients) • Standardised format • Personalised information • Brief explanation regarding medical terms • Prompt question

  8. Topics Weight BMI BP Blood sugar range Exercise Diet HbA1c ACR Creatinine Cholesterol LDL TG HDL Diabetic medication Diabetic complication Other problems Other medications

  9. Clinical Information Sheet (1) The following is a brief summary of information on your diabetes. Please take the time to read it. All members of our team will be happy to answer any of your questions. Below are explanations of the medical terms used in this form. If you need further clarification, please ask a member of the healthcare team. HbA1C is a blood test used to monitor long term blood sugar control. ACR (Albumin Creatinine Ratio) and creatinine are indicators of your kidney function. Cholesterol is the main type of fat that we worry about in the blood. LDL and TG (triglyceride) are the bad cholesterol. HDL is the good cholesterol. ‘Onsets’ refer to date of onset of complications of your diabetes, if you have any. Please consider the following question: What do I wish to get out of today’s visit to the Diabetes clinic?

  10. Clinical Information Sheet (2)

  11. Methods Subjects – Patients attending Diabetes Clinics in Galway University Hospitals Recruitment over a 5 week period 6 intervention clinics and 3 control clinics Total patients = 106 (65 males and 41 females)

  12. Methods Data were recorded in 3 ways • The percent of patients initiating each individual topic • The number of topics initiated by each individual patient • The patients’ conversation time vs. total consultation time

  13. Percent of Patients Initiating Individual Topics

  14. Patient score Mean patient score Control group = 1 (range 0-4) Intervention group = 5 (range 0-14) No topics raised Control group (49%) Intervention group (16%)

  15. Patient Conversation Time vs. Total Consultation Time P>0.05 P<0.05

  16. Summary A personalised clinical information sheet in routine clinical practice is associated with: Increase in number of patients initiating individual topics Increase in number of topics being initiated by individual patients Increase in patient conversation time No significant lengthening of consultation

  17. Conclusion The clinical information sheet facilitates patient involvement in the consultation

  18. Study Limitations • Not a randomised controlled trial • No data collected on patients clinical or psychosocial outcomes • No control for possible confounding factors • Patients demographic, clinical, psychosocial factors • Doctors characteristics • Doctors not blinded to patients in the intervention group • Risk of observer bias

  19. Further questions • Does the type of clinical information shared with patients influence their involvement in the consultation (personalised clinical information V general information on topics)? • How does such involvement impact on clinician behaviour?

  20. Proposed research Quantitative study Aim • To explore the impact of sharing different types of clinical information with Type 2 diabetes patients on patient involvement in the consultation and patient-related outcomes

  21. Hypotheses • Patients receiving an information intervention will be more involved in the consultation and have better outcomes than those in the control group • Patients who receive personalised clinical data will be more involved in the consultation than those that receiving general clinical information only.

  22. Study design (1)

  23. Study design (2) Historical control Pre-intervention

  24. Outcome measures Quantitative study • Primary outcome • Patient involvement in the consultation • Patient outcomes • Patient satisfaction with the consultation • Quality of life measure • Self care behaviour (e.g. adherence to medication, blood glucose testing, exercise, diet) • Diabetes self efficacy measure • Depression/Anxiety • Secondary outcome measures • HbA1c • Cholesterol (?) • Body mass index(?)

  25. Data collection • Audiotaping of consultations • Patient questionnaires • Medical record data extraction

  26. Audiotaping of consultations • The percent of patients initiating each individual topic • The number of topics initiated by each individual patient • The patients’ conversation time vs. total consultation time

  27. Baseline questionnaire Baseline • Demographics (Age, Gender, education) • Psychosocial measures • Quality of life • Self care behaviour • Diabetes self efficacy • Depression/anxiety • Preference for involvement in the consultation

  28. Patient questionnaire straight after consultation • Patient perceived involvement in the consultation • Patient satisfaction with the consultation • Patient perception of facilitation of involvement

  29. Patient questionnaire 6 weeks post consultation Psychosocial measures • Quality of life • Self care/self management • Diabetes self efficacy • Depression/anxiety • Preference for involvement in the consultation

  30. Medical record data (1) Baseline data • Number of previous visits • Duration of Diabetes • On insulin or medication • Co morbidities

  31. Medical record data (2) Post intervention • At 6 months(?) or whenever patients next visit to clinic is? • HbA1c • Cholesterol • BMI

  32. Qualitative study Aim To explore the nature of patient engagement in the consultation and how this impacts on clinician behaviour

  33. Methods • Data analyses In-depth analyses of the nature of patients involvement in the consultation and how doctors respond to such involvement

  34. Thanks Any thoughts/comments?

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