Simple communication technique may imrpove health outcomes among diabetes patients, but is underused

Diabetes management may improve when physicians use an interactive communication technique with patients. Unfortunately, physicians underuse this simple strategy, according to a new study, which appears in the January 13, 2003 issue of The Archives of Internal Medicine.

Prior research has shown that patients fail to recall or comprehend as much as half of what they are told by their physicians, according to UCSF researchers. “In this study, we tried to identify simple communication techniques that make physicians more effective teachers,” said Dean Schillinger, MD, UCSF assistant professor of medicine at San Francisco General Hospital Medical Center (SFGHMC) and lead author of the study.

The investigators used audio tapes of actual visits at a public hospital’s clinics to measure the extent to which primary care physicians interacted with their patients to assess patient recall and comprehension of new concepts. They recorded visits between 38 physicians and 74 English-speaking patients with diabetes and poor health literacy. Study findings showed that physicians used this interactive technique in only 20 percent of visits and for only 12 percent of new concepts, explained Schillinger.

Patients with poor health literacy may experience problems ranging from reading labels on a pill bottle, interpreting blood sugar values or dosing schedules, and comprehending appointment slips and educational brochures. They are more likely to have troubles with oral communication, as well,” said Schillinger.  He explained that poor health literacy is common in public hospital settings and among the elderly.

“Some physicians asked patients to respond to newly delivered information, while other physicians asked patients to restate the instructions or ‘teach back’ the information. Patients whose physicians explicitly assess recall or comprehension in these ways were more likely to have good diabetes control, said Schillinger. “We found that using this strategy did not require lengthier visits. By checking patients’ recall and comprehension or critical concepts, more physicians may be able to effectively partner with their diabetes patients to achieve better outcomes.”

Additional investigators on the study include John Piette, PhD, associate professor of medicine, Center for Practice Management and Outcomes Research, VA Ann Arbor Health Care System, Ann Arbor, MI; Kevin Grumbach, MD, UCSF professor of family and community medicine; Frances Wang, MS, UCSF department of medicine;  Clifford Wilson, BA, UCSF department of medicine;  Carolyn Daher, MPH, UCSF department of medicine; Krishelle Leong-Grotz, BS, Case Western Reserve University; Cesar Castro, MD, University of California Berkeley; and Andrew Bindman, MD, UCSF professor of medicine, epidemiology, and biostatistics.

The study was supported by the Agency for Healthcare Research and Quality (AHRQ), the UCSF Hellman Family Early Career Research Award, the Pfizer Inc. Health Literacy Research Award, and the UCSF General Clinical Research Center at SFGHMC.

AHRQ, a part of the U.S. Public Health Service, is the lead agency charged with supporting research designed to improve the quality of health care, reduce its cost, improve patient safety, address medical errors, and broaden access to essential services.  AHRQ sponsors and conducts research that provides evidence-based information on health care outcomes; quality; and cost, use, and access. 

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