Diabetes oral medication initiation and intensification: patient views compared with current treatment guidelines

Journal Name: 
Diabetes Educ
Authors: 
Grant,R.W.
Pabon-Nau,L.
Ross,K.M.
Youatt,E.J.
Pandiscio,J.C.
Park,E.R.
Abstract: 
PURPOSE: The purpose of this study was to compare patient perceptions about medication management with principles underlying American Diabetes Association (ADA) published treatment algorithms. METHODS: Six focus groups (4 English and 2 Spanish) were conducted with 50 patients with type 2 diabetes. Patients were asked about their prior experiences with initiating and changing oral medicines. They were also shown a medication plan for a hypothetical patient depicting future potential changes to achieve glycemic control. Coded responses were mapped to 3 concepts implicit in the ADA recommended treatment algorithm: (1) prescribing medicines to achieve A1c goal is beneficial, (2) medical regimens are generally intensified, and (3) intensification should be timely. RESULTS: Patient perceptions contrasted markedly with the treatment algorithm: (1) most patients had negative perceptions of medication initiation, viewing this event as evidence of personal failure and an increased burden; (2) patients equated medication intensification with increased risk for diabetes-related complications (rather than a step to reduce future risk) and viewed de-escalation as a primary goal; and (3) no patients expressed concerns about delays in medication intensification. Patients responded very favorably to an individualized medication plan depicting future potential changes. CONCLUSIONS: Patients in this study described a conceptual model for medication therapy that contrasted in critical ways from the principles of current treatment guidelines. Underscoring the key role of patient-provider communication, the results suggest that effective counseling should also include an informed discussion of future medication intensification
1
2011
Volume: 
37
Pages: 
78-84
Keywords: 
50, administration & dosage, Administration,Oral, Algorithms, Boston, Communication, complications, Counseling, Diabetes, Diabetes Mellitus,Type 2, Drug Therapy, electronic, Female, Focus Groups, Guideline Adherence, Guidelines, Health Knowledge,Attitudes,Practice, hospital, Humans, Hypoglycemic Agents, Male, Massachusetts, medical, Medicine, Methods, Middle Aged, patient, Patients, Perception, perceptions, Physician-Patient Relations, Practice Guidelines as Topic, Research, Research Support, response, Risk, Role, support, therapy