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Factors that influence the intended intensity of diabetes care in a person‐centred setting
Author(s) -
Vugt H. A.,
Heijmans M. J. W. M.,
Koning E. J. P.,
Rutten G. E. H. M.
Publication year - 2020
Publication title -
diabetic medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.474
H-Index - 145
eISSN - 1464-5491
pISSN - 0742-3071
DOI - 10.1111/dme.14072
Subject(s) - medicine , odds ratio , odds , referral , intensive care , diabetes mellitus , family medicine , intensive care medicine , logistic regression , endocrinology
Aims To assess the intended intensity of Type 2 diabetes care and the factors associated with that intensity of care after the annual monitoring visit in which a new person‐centred diabetes consultation model including shared decision making was used. Methods We conducted an observational study in 1284 people from 47 general practices and six hospital outpatient clinics. Intensity of care (more, no/minimal change, less) was based on monitoring frequency and referral to other care providers. We used multivariable analyses to determine the factors that were independently associated with intensity of care. Care providers also reported three factors which, in their opinion, determined the intensity of care. Results After the consultation, 22.8% of people chose more intensive care, 70.6% chose no/minimal change and 6.6% chose less intensive care. Whether care became more intensive vs not/minimally changed was associated with a high educational level (odds ratio 1.65, CI 1.07 to 2.53; P =0.023), concern about illness (odds ratio 1.08; CI 1.00 to 1.17; P =0.045), goal‐setting (odds ratio 6.53, CI 3.79 to 11.27; P <0.001), comorbidities (odds ratio 1.12, CI 1.00 to 1.24; P =0.041) and use of oral blood glucose lowering medication (odds ratio 0.59, CI 0.39 to 0.89; P =0.011). Less intensive care vs no/minimal change was associated with lower diabetes distress levels (odds ratio 0.87, CI 0.79 to 0.97; P =0.009). According to care providers, quality of life, lifestyle, person's preferences and motivation, glycaemic control, and self‐management possibilities most frequently determined the intended care. Conclusions In person‐centred diabetes care, the intended intensity of care was associated with both disease‐ and person‐related factors.