EMGO Research Institute

Amsterdam, Netherlands

EMGO Research Institute

Amsterdam, Netherlands
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Bos-Touwen I.D.,University Utrecht | Trappenburg J.C.A.,University Utrecht | Van Der Wulp I.,EMGO Research Institute | Schuurmans M.J.,University Utrecht | De Wit N.J.,University Utrecht
PLoS ONE | Year: 2017

Background and aim: Self-management support is an integral part of current chronic care guidelines. The success of self-management interventions varies between individual patients, suggesting a need for tailored self-management support. Understanding the role of patient factors in the current decision making of health professionals can support future tailoring of self-management interventions. The aim of this study is to identify the relative importance of patient factors in health professionals' decision making regarding self-management support. Method: A factorial survey was presented to primary care physicians and nurses. The survey consisted of clinical vignettes (case descriptions), in which 11 patient factors were systematically varied. Each care provider received a set of 12 vignettes. For each vignette, they decided whether they would give this patient self-management support and whether they expected this support to be successful. The associations between respondent decisions and patient factors were explored using ordered logit regression. Results: The survey was completed by 60 general practitioners and 80 nurses. Self-management support was unlikely to be provided in a third of the vignettes. The most important patient factor in the decision to provide self-management support as well as in the expectation that self-management support would be successful was motivation, followed by patient-provider relationship and illness perception. Other factors, such as depression or anxiety, education level, self-efficacy and social support, had a small impact on decisions. Disease, disease severity, knowledge of disease, and age were relatively unimportant factors. Conclusion: This is the first study to explore the relative importance of patient factors in decision making and the expectations regarding the provision of self-management support to chronic disease patients. By far, the most important factor considered was patient's motivation; unmotivated patients were less likely to receive self-management support. Future tailored interventions should incorporate strategies to enhance motivation in unmotivated patients. Furthermore, care providers should be better equipped to promote motivational change in their patients. © 2017 Bos-Touwen et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


Hajos T.R.S.,University Medical Center | Hajos T.R.S.,EMGO Research Institute | Pouwer F.,University of Tilburg | de Grooth R.,Sanofi S.A. | And 6 more authors.
Diabetic Medicine | Year: 2011

Aims To study prospectively the impact of initiating insulin glargine in suboptimally controlled insulin-naïve patients with Type2 diabetes on health-related quality of life in relation to glycaemic control. Methods Insulin-naïve Dutch patients with Type2 diabetes in suboptimal glycaemic control (HbA 1c >53mmol/mol; 7%) on maximum dose of oral glucose-lowering medications were included from 363 primary care practices (n=911). Patients started insulin glargine and were followed up for 6months. At baseline (start insulin therapy), 3 and 6months, HbA 1c was measured and patients completed self-report health-related quality of life measures, including emotional well-being (World Health Organization-5 well-being index), fear of hypoglycaemia (Hypoglycaemia Fear Survey) and diabetes symptom distress (Diabetes Symptom Checklist-revised). Data were analysed using generalized estimating equations analysis. Results HbA 1c (mmol/mol; %) decreased from 69±16; 8.5±1.7 to 60±11; 7.6±1.0 and 57±11; 7.3±1.0 at 3 and 6months, respectively (P<0.001). Pre-insulin BMI (kg/m 2) was 30±5.7, which remained stable at 3months (30±5.8) and increased to 31±5.9 at 6months (P=0.004); no significant changes in self-reported symptomatic and severe hypoglycaemia were observed, while nocturnal hypoglycaemia slightly decreased. The Hypoglycaemia Fear Survey score decreased from 14.6±16.2 to 12.1±15.2 and 10.8±14.4 at 3 and 6months, respectively (P<0.001). The Diabetes Symptom Checklist-revised score decreased from 15±14 to 10±12 and 10±13 (P<0.001), with most pronounced reductions in hyperglycaemic symptoms and fatigue. The World Health Organization-5 score increased from 57±25.3 to 65±21.6 at 3-month follow-up and 67±21.8 at 6-month follow-up (P<0.001). Conclusions Results of this observational study demonstrate combined glycaemic and health-related quality of life benefits of initiating insulin glargine in patients with Type2 diabetes in routine primary care. © 2011 The Authors. Diabetic Medicine © 2011 Diabetes UK.

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