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No moment wasted: the primary-care visit for adults with diabetes and low socio-economic status.

Bolen SD, Sage P, Perzynski AT, Stange KC - Prim Health Care Res Dev (2015)

Bottom Line: Physicians most frequently initiated discussions about chronic diseases, prevention, and health behavior.Patients most frequently initiated discussions about social environment and acute symptoms followed by prevention and health behavior.Emerging new models of primary-care delivery and quality measurement should allow adequate time and resources to address the range of tasks necessary for integrating biomedical and psychosocial concerns to improve the health of socio-economically disadvantaged patients.

View Article: PubMed Central - PubMed

Affiliation: 1Department of Medicine,Center for Health Care Research and Policy,Case Western Reserve University,MetroHealth Medical Center,Cleveland,Ohio,USA.

ABSTRACT

Aim: To better understand the type and range of health issues initiated by patients and providers in 'high-quality' primary-care for adults with diabetes and low socio-economic status (SES).

Background: Although quality of care guidelines are straightforward, diabetes visits in primary care are often more complex than adhering to guidelines, especially in adults with low SES who experience many financial and environmental barriers to good care.

Methods: We conducted a qualitative study using direct observation of primary-care diabetes visits at an exemplar safety net practice in 2009-2010. Findings In a mainly African American (93%) low-income population with fair cardiovascular control (mean A1c 7.5%, BP 134/81 mmHg, and low-density lipoprotein cholesterol 100 mg/dL), visits addressed a variety of bio-psychosocial health issues [median: 25 problems/visit (range 13-32)]. Physicians most frequently initiated discussions about chronic diseases, prevention, and health behavior. Patients most frequently initiated discussions about social environment and acute symptoms followed by prevention and health behavior.

Conclusions: Primary-care visits by diabetes patients with low SES address a surprising number and diversity of problems. Emerging new models of primary-care delivery and quality measurement should allow adequate time and resources to address the range of tasks necessary for integrating biomedical and psychosocial concerns to improve the health of socio-economically disadvantaged patients.

No MeSH data available.


Related in: MedlinePlus

Median (interquartile range) number of health issues per visit and median visit length at 15 diabetic visits in primary care
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fig1: Median (interquartile range) number of health issues per visit and median visit length at 15 diabetic visits in primary care

Mentions: The mean visit length was 28 min (Figure 1). A median of 25 health issues per visit were addressed (Figure 1), including a wide variety of acute and chronic medical, psychological, and social concerns (Figure 2). Primary-care physicians more frequently initiated discussions about chronic disease management and prevention (23 and 21% of 365 total health issues, respectively, at 15 patient encounters), whereas patients more frequently initiated discussions about acute health concerns and social issues related to health (16 and 29% of total health issues, respectively). The count of health issues does not include health education or personal discussions unrelated to health.Figure 1


No moment wasted: the primary-care visit for adults with diabetes and low socio-economic status.

Bolen SD, Sage P, Perzynski AT, Stange KC - Prim Health Care Res Dev (2015)

Median (interquartile range) number of health issues per visit and median visit length at 15 diabetic visits in primary care
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4697285&req=5

fig1: Median (interquartile range) number of health issues per visit and median visit length at 15 diabetic visits in primary care
Mentions: The mean visit length was 28 min (Figure 1). A median of 25 health issues per visit were addressed (Figure 1), including a wide variety of acute and chronic medical, psychological, and social concerns (Figure 2). Primary-care physicians more frequently initiated discussions about chronic disease management and prevention (23 and 21% of 365 total health issues, respectively, at 15 patient encounters), whereas patients more frequently initiated discussions about acute health concerns and social issues related to health (16 and 29% of total health issues, respectively). The count of health issues does not include health education or personal discussions unrelated to health.Figure 1

Bottom Line: Physicians most frequently initiated discussions about chronic diseases, prevention, and health behavior.Patients most frequently initiated discussions about social environment and acute symptoms followed by prevention and health behavior.Emerging new models of primary-care delivery and quality measurement should allow adequate time and resources to address the range of tasks necessary for integrating biomedical and psychosocial concerns to improve the health of socio-economically disadvantaged patients.

View Article: PubMed Central - PubMed

Affiliation: 1Department of Medicine,Center for Health Care Research and Policy,Case Western Reserve University,MetroHealth Medical Center,Cleveland,Ohio,USA.

ABSTRACT

Aim: To better understand the type and range of health issues initiated by patients and providers in 'high-quality' primary-care for adults with diabetes and low socio-economic status (SES).

Background: Although quality of care guidelines are straightforward, diabetes visits in primary care are often more complex than adhering to guidelines, especially in adults with low SES who experience many financial and environmental barriers to good care.

Methods: We conducted a qualitative study using direct observation of primary-care diabetes visits at an exemplar safety net practice in 2009-2010. Findings In a mainly African American (93%) low-income population with fair cardiovascular control (mean A1c 7.5%, BP 134/81 mmHg, and low-density lipoprotein cholesterol 100 mg/dL), visits addressed a variety of bio-psychosocial health issues [median: 25 problems/visit (range 13-32)]. Physicians most frequently initiated discussions about chronic diseases, prevention, and health behavior. Patients most frequently initiated discussions about social environment and acute symptoms followed by prevention and health behavior.

Conclusions: Primary-care visits by diabetes patients with low SES address a surprising number and diversity of problems. Emerging new models of primary-care delivery and quality measurement should allow adequate time and resources to address the range of tasks necessary for integrating biomedical and psychosocial concerns to improve the health of socio-economically disadvantaged patients.

No MeSH data available.


Related in: MedlinePlus