Implementation of a Structured Diabetes Consultation Model to Facilitate a Person-Centered Approach: Results From a Nationwide Dutch Study.

Abstract

We assessed both from a patient and provider perspective the usefulness and added value of a consultation model that facilitates person-centered diabetes care. The model consists of <i>1</i>) inventory of disease and patient-related factors; <i>2</i>) setting personal goals; <i>3</i>) choosing treatment; and <i>4</i>) determination of required care. It was implemented in 47 general practices and 6 hospital outpatient clinics. Providers were trained, and patients were recommended to prepare their visit. All filled out a questionnaire after every consultation. Differences between primary and secondary care practices and between physician-led and nurse-led consultations were analyzed. Seventy-four physicians and thirty-one nurses participated, reporting on 1,366 consultations with type 2 diabetes patients. According to providers, the model was applicable in 72.4% (nurses 79.3% vs. physicians 68.5%, <i>P</i> < 0.001). Physicians more often had a consultation time <25 min (80.4% vs. 56.9%, <i>P</i> < 0.001). According to providers, two of three patients spoke more than half of the consultation time (outpatient clinics 75.2% vs. general practices 66.6%, <i>P</i> = 0.002; nurses 73.2% vs. physicians 64.4%, <i>P</i> = 0.001). Providers stated that person-related factors often determined treatment goals. Almost all patients (94.4%) reported that they made shared decisions; they felt more involved than before (with physicians 45.1% vs. with nurses 33.6%, <i>P</i> < 0.001) and rated the consultation 8.6 of 10. After physician-led consultations, 52.5% reported that the consultation was better than before (nurse visit 33.7%, <i>P</i> < 0.001). A consultation model to facilitate person-centered care seems well applicable and results in more patient involvement, including shared decision making, and is appreciated by a substantial number of patients.