Implementation of a structured diabetes consultation model to facilitate a person-centered Approach: Results from a nationwide Dutch study

Abstract

OBJECTIVE We assessed both from a patient and provider perspective the usefulness and added value of a consultation model that facilitates person-centered diabetes care. RESEARCH DESIGN AND METHODS The model consists of 1) inventory of disease and patient-related factors; 2) setting personal goals; 3) choosing treatment; and 4) determination of required care. It was implemented in 47 general practices and 6 hospital outpatient clinics. Providerswere 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 consultationswere analyzed. RESULTS 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%, P<0.001). Physicians more often had a consultation time <25 min (80.4% vs. 56.9%, P<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%, P = 0.002; nurses 73.2% vs. physicians 64.4%, P = 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%, P < 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%, P<0.001). CONCLUSIONS A consultation model to facilitate person-centered care seems well applicable and results inmore patient involvement, incluDing shared decisionmaking, and is appreciated by a substantial number of patients.