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Research ArticleOriginal Research

Participatory Decision Making, Patient Activation, Medication Adherence, and Intermediate Clinical Outcomes in Type 2 Diabetes: A STARNet Study

Michael L. Parchman, John E. Zeber and Raymond F. Palmer
The Annals of Family Medicine September 2010, 8 (5) 410-417; DOI: https://doi.org/10.1370/afm.1161
Michael L. Parchman
MD, MPH
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John E. Zeber
PhD
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Raymond F. Palmer
PhD
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    Figure 1.

    Path analysis depicting the associations between PDM, activation, medication adherence, and clinical outcome.

    Hemoglobin A1c=glycated hemoglobin; LDL=low-density lipoprotein; PDM=participatory decision making.

    Note: refer to Table 3⇑ for specific coefficients for each of the labeled paths: b1, b2, and b3.

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    Table 1.

    Summary Description of Scales Used in Analyses

    Baseline ScoreFollow-up Score
    VariableMeaning of High ScorenMean (SD); RangenMean (SD)P Value
    NA=not applicable.
    aDetermined by paired t test.
    Participatory decision makingGreater participatory decision making602.40 (1.14); 1–5NANANA
    Patient activationHigher level of patient activation16212.48 (3.53); 3–1814313.31 (3.61).014
    Medication adherenceMore problems with medication adherence1561.23 (0.97); 0–41451.10 (0.93).017
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    Table 2.

    Parameters of the Latent Growth Curve Model for Hemoglobin A1c, Systolic Blood Pressure, and LDL Cholesterol

    Model Parameters
    MeasureMean (SE)SignVariance (SE)P ValueModel Fit χ2 (df); CFI; RMSEA
    Hemoglobin A1c=glycated hemoglobin; CFI=Comparative Fit Index; df = degree of freedom; LDL = low-density lipoprotein; RMSEA = root mean square error of approximation.
    Hemoglobin A1c26.9 (30); 0.99; 0.030
        Baseline7.05 (0.97)<.0012.05 (.275)<.001
        Rate of change−0.03 (0.015)<.100.10 (.017)<.001
    Systolic blood pressure57.0 (30); 0.97; 0.044
        Baseline130.41 (.98)<.001177.38 (21.88)<.001
        Rate of change−0.30 (0.15)<.052.52 (0.58)<.001
    LDL cholesterol60.6 (30); 0.93; 0.059
        Baseline102.89 (2.30)<.001847.00 (116.20)<.001
        Rate of change−2.89 (0.48)<.00111.14 ( 5.80)<.01
    • View popup
    Table 3.

    Regression Weights of Study Variables on Outcome Rates of Change From Structural Equation Models

    Hemoglobin A1cSystolic Blood PressureLDL Cholesterol
    PathIndependent VariableDependent VariableRegression Coefficient (SE)P ValueRegression Coefficient (SE)P ValueRegression Coefficient (SE)P Value
    A1 = glycated hemoglobin; LDL = low-density lipoprotein; PDM = participatory decision making.
    Note: See Figure 1 for path descriptions.
    aMeasured by Kaplan-Greenfield scale.
    bMeasured by Lorig communication scale.
    cStandardized regression coefficient.
    dMeasured by Morisky scale.
    b3PDMaPatient activation follow-upb0.44 (0.21); −0.14c.030.43 (0.21); 0.14c0.040.42 (0.21); 0.14c.04
    b2Patient activation follow-upMedication adherence follow-upd−0.04 (0.02); −0.16c.02−0.004 (0.02); −0.15c0.02−0.04 (0.02); −0.16c.02
    b1Medication adherence follow-upRate of change in outcome0.04 (0.02); 0.26c.050.04 (0.17); 0.05c0.801.08 (0.53); 0.40c.04

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  • The Article in Brief

    Participatory Decision Making, Patient Activation, Medication Adherence, and Intermediate Clinical Outcomes in Type 2 Diabetes: A STARNet Study

    Michael L. Parchman , and colleagues

    Background Participatory decision making, in which patients actively participate in the medical visit, is associated with better outcomes in patients with chronic illnesses. This study of patients with type 2 diabetes aimed to shed light on the pathway between a clinician's participatory decision-making style, patient participation in the visit, and taking medication as prescribed.

    What This Study Found Diabetes patients who reported a higher level of participatory decision making were more likely to actively participate in the medical visit. Active participation in the visit was associated with taking medications as prescribed, and taking medications as prescribed was associated with improved control of hemoglobin A1C levels and LDL cholesterol levels (but not blood pressure).

    Implications

    • Actively involving patients in decision making about their care requires adequate visit time and resources. This will require a fundamental restructuring and transformation of many primary care settings.
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The Annals of Family Medicine: 8 (5)
The Annals of Family Medicine: 8 (5)
Vol. 8, Issue 5
1 Sep 2010
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Participatory Decision Making, Patient Activation, Medication Adherence, and Intermediate Clinical Outcomes in Type 2 Diabetes: A STARNet Study
Michael L. Parchman, John E. Zeber, Raymond F. Palmer
The Annals of Family Medicine Sep 2010, 8 (5) 410-417; DOI: 10.1370/afm.1161

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Participatory Decision Making, Patient Activation, Medication Adherence, and Intermediate Clinical Outcomes in Type 2 Diabetes: A STARNet Study
Michael L. Parchman, John E. Zeber, Raymond F. Palmer
The Annals of Family Medicine Sep 2010, 8 (5) 410-417; DOI: 10.1370/afm.1161
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