Purpose This study was conducted to evaluate if the style of physician interaction during primary care visits was associated with control of glucose, blood pressure, and lipids in patients with type 2 diabetes.
Methods This was a cross-sectional observational study conducted in 20 primary care clinics. Thirty consecutive adult patients presenting with a diagnosis of type 2 diabetes were enrolled in each clinic. Of these patients, the first 8-10 physician visits in each clinic were audio-recorded. One investigator coded the predominant activity for each 15-second interval of all visits using the Davis Observation Code (DOC). Physician practice interaction style was calculated by taking the mean value of each code for each physician across all visits. In order to develop a more stable estimate of physician interaction style, only physicians with three or more visits were used for analysis. Patients' charts were abstracted to collect data on demographics and most recent values of HbA1c, blood pressure (BP), and LDL cholesterol. Multilevel modeling was used to account for the nesting of patients within physician.
Results A total of 188 physician-patient encounters to 43 different physicians were recorded, 162 in English, 26 in Spanish. Of these physicians, 24 had three or more patient visits recorded and these were used for analysis (total of 137 visits). Multilevel analysis revealed that time spent on health education was inversely associated with HbA1c values (p = .036). Each minute the physician discussed health education was associated with a 0.24 decrease in the HbA1c. Time spent on health education was not associated with LDL cholesterol (p = .2) or blood pressure (p = .1). Time spent on evaluation and feedback of laboratory and study results was inversely associated with HbA1c (p = .001), LDL cholesterol (p = .017), and blood pressure (p = .015).
Conclusions Patients seen by primary care physicians who spend more time on health education during the visit have better control of their glucose. Future research is needed to see if evaluation and feedback of laboratory and study results encourage patient participation in their care leading to improved control of blood pressure, lipids, and glucose.
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