Reimbursement Decision-Making and Prescription Patterns of Glitazones in Treatment of Type 2 Diabetes Mellitus Patients in Denmark

Abstract Background We investigate whether an educational intervention of GPs increases patient-centeredness and perceived shared decision making in the treatment of patients with poorly controlled type 2 diabetes mellitus? Methods We performed a cluster-randomized controlled trial in German primary care. Patients with type 2 diabetes mellitus defined as HbA1c levels ≥ 8.0% (64 mmol/mol) at the time of recruitment (n = 833) from general practitioners (n = 108) were included. Outcome measures included subjective shared decision making (SDM-Q-9; scale from 0 to 45 (high)) and patient-centeredness (PACIC-D; scale from 1 to 5 (high)) as secondary outcomes. Data collection was performed before intervention (baseline, T0), at 6 months (T1), at 12 months (T2), at 18 months (T3), and at 24 months (T4) after baseline. Results Subjective shared decision making decreased in both groups during the course of the study (intervention group: -3.17 between T0 and T4 (95% CI: -4.66, -1.69; p < 0.0001) control group: -2.80 (95% CI: -4.30, -1.30; p = 0.0003)). There were no significant differences between the two groups (-0.37; 95% CI: -2.20, 1.45; p = 0.6847). The intervention's impact on patient-centeredness was minor. Values increased in both groups, but the increase was not statistically significant, nor was the difference between the groups. Conclusions The intervention did not increase patient perceived subjective shared decision making and patient-centeredness in the intervention group as compared to the control group. Effects in both groups might be partially attributed to the Hawthorne-effect. Future trials should focus on patient-based intervention elements to investigate effects on shared decision making and patient-centeredness. Trial registration The trial was registered on March 10th, 2011 at ISRCTN registry under the reference ISRCTN70713571.

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Is collaborative decision making and goal setting effective in the treatment of type 2 diabetes mellitus?

Evidence-Based Practice ◽

10.1097/ebp.0000000000001057 ◽

2020 ◽

Vol Publish Ahead of Print ◽

Author(s):

Seth Leavitt ◽

Debra Koenigsberger

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Decision Making ◽

Type 2 Diabetes Mellitus ◽

Goal Setting ◽

Collaborative Decision Making ◽

Collaborative Decision

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Improving access to shared decision-making for Hispanics/Latinos with inadequately controlled type 2 diabetes mellitus

Patient Preference and Adherence ◽

10.2147/ppa.s80552 ◽

2015 ◽

pp. 619

Author(s):

Alicia Shillington ◽

Jaime A Davidson ◽

Aracely Rosales ◽

Robert Bailey ◽

Chris Kabir ◽

...

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Decision Making ◽

Type 2 Diabetes Mellitus ◽

Shared Decision Making ◽

Shared Decision

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Factors influencing self-management priority setting and decision-making among Chinese patients with acute coronary syndrome and type 2 diabetes mellitus

European Journal of Cardiovascular Nursing ◽

10.1177/1474515119863178 ◽

2019 ◽

Vol 18 (8) ◽

pp. 700-710 ◽

Cited By ~ 1

Author(s):

Xian-Liang Liu ◽

Karen Willis ◽

Paul Fulbrook ◽

Chiung-Jung (Jo) Wu ◽

Yan Shi ◽

...

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Decision Making ◽

Type 2 Diabetes Mellitus ◽

Acute Coronary Syndrome ◽

Priority Setting ◽

Self Management ◽

Internal Factors ◽

Coronary Syndrome

Background: Priority setting and decision-making in relation to self-management of multiple conditions is particularly challenging for both patients and health professionals. The aim of this study was to validate a conceptual model of self-management priority setting and decision-making in multimorbidity and confirm factors that influence self-management prioritizing and decision-making in a sample of patients with acute coronary syndrome and type 2 diabetes mellitus. Methods: This was a qualitative study using deductive directed content analysis. A purposive sample of 21 participants with acute coronary syndrome and type 2 diabetes mellitus that were admitted to a Shanghai hospital were interviewed. Results: Participants provided evidence to confirm all but one of the factors from the conceptual model. Internal factors influencing self-management predominated. Agreement with recommended treatment, functional capacity and perceived synergies, antagonistic effects, or interactions among the conditions and prescribed treatments, was emphasized. The facilitators and barriers to priority setting and decision-making were related to available resources, provider communication and, to a lesser extent, confusion about recommendations, and treatment complexity. Some participants were also concerned about treatment side effects. Conclusions: Internal factors (personal beliefs, preferences, and attitudes) and facilitators and barriers (knowledge, finances, social support, and transportation) were related to changes in priority setting and decision-making and self-management behavior in this sample. Health education, which includes case studies with shifting self-management priorities is recommended, rather than a unique disease-specific focus. Further research, exploring the relationship between these factors and changes in the dominant condition and related management, using valid and reliable instruments that capture these key factors, is recommended.

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