4L-1 BARRIERS TO SELF-MANAGEMENT IN PATIENTS WITH DIABETES. WHAT MATTERS?

Tuesday, October 25, 2016: 3:30 PM
Bayshore Ballroom Salon F, Lobby Level (Westin Bayshore Vancouver)

Dominik Ose, PhD, MPH1, Mark S. Roberts, MD, MPH2, Gary S. Fischer, MD3, Sunday Clark, Sc.D.4, Angela Fagerlin, PhD5 and Rachel Hess, MD, MS1, (1)University of Utah, Department of Population Health Sciences, Division of Health System Innovation and Research, Salt Lake City, UT, (2)Department of Health Policy and Management, University of Pittsburgh, Pittsburgh, PA, (3)University of Pittsburgh, School of Medicine, Pittsburgh, PA, (4)Weill Cornell Medical College, Cornell University, New York, NY, (5)University of Utah, Department of Population Health Sciences, Salt Lake City, UT
Purpose: To compare barriers to self-management (BSM) in older primary care patients with and without diabetes.

Method: Participants were recruited from 73 primary care practices throughout Western Pennsylvania between 2010-2011. Patients completed questionnaires regarding socio-demographic data, race and ethnicity, and income, health literacy (HL), medical conditions, and BSM (47 questions). All BSM scores (overall BSM-score and 11 BSM-domain scores: overall health, physical functioning, social activities, depression, patient- physician communication, cost of care, inconvenience, medication adherence, knowledge about conditions, multi-morbidity, self-efficacy) were normalized to a 0–100 scale and standardized so that higher values represent less barriers. We compared all BSM-domains scores (mean, SD) in patients with diabetes to those without diabetes using t-tests and the overall BSM score using ANCOVA with all main effects considered including level of education, marital status, race, age, and income.

Result: 1,169 patients were included in our analysis; 428 (36.6%) had diabetes. Patients with and without diabetes were similar with respect to sex (P=0.758) and age (P=0.234).  Participants with diabetes were less likely to be married or cohabiting (P=0.008), more likely to be African American (P=0.003), and more likely to have income <$34,999 (P<0.001). Participants with diabetes also had slightly lower health literacy (HL-score 5.1 vs 5.0; P=0.001). 

The mean values of all but two BSM-domains scores (exceptions being “social activities” and “patient- physician-communication”) were significantly lower for patients with diabetes compared to patients without diabetes, indicating higher barriers to self-management. This was particularly notable in the barriers of “overall health” (47.0 vs 59.3; P<0.001), “self-efficacy” (71.9 vs 77.2; P<0.001) and “feeling overwhelmed” (62.4 vs 67.8; P<0.001). The ANCOVA showed, that having diabetes [F (1, 1169) =17.39; P< 0.001], higher age [F (1, 1169) = 17.13; P< 0.001] and lower income [F (2, 1169) = 31.78; P< 0.001] was significantly associated with worse overall BSM-score.

Conclusion: Patients with diabetes reported increased self-reported barriers to self-management. Those with lower income may be particularly at risk. Interventions should strengthen self-efficacy capabilities, knowledge about the disease and skills to handle overwhelming situations.

See more of: ORAL ABSTRACTS: CHRONIC DISEASE MANAGEMENT

See more of: 38th Annual North American Meeting of the Society for Medical Decision Making