Medical systems and patient-provider relationships

Abstract

This chapter examines how aspects of patient-centered communication are central to meeting the complex demands of managing diabetes in adulthood. We initially operationalize patient-centered care and describe the processes posited to link patient-centered interactions to better diabetes management. We then selectively review the literature to address four central issues. First, we discuss what patients want from their interactions with health-care providers. Qualitative studies reveal patients want open, honest, autonomy-supportive communication that encourages collaborative relationships with health-care providers. Second, we determine whether these characteristics are associated with diabetes outcomes (e.g., quality of life, diabetes self-management, glycemic control). Cross-sectional and longitudinal observational studies indicate that comprehensive discussions about diabetes and its treatment that empower patients to participate in treatment decisions are associated with better diabetes outcomes. Third, we examine whether interventions to promote patient-centered interactions are effective and improve diabetes outcomes. Interventions targeting patients or multifaceted aspects of the health-care system have been effective at improving intermediate outcomes (e.g., satisfaction with care) but less conclusively improve diabetes outcomes. Fourth, we discuss how health-care systems are associated with patient-centered care and diabetes outcomes. Although traditional models of care may hinder the delivery of patient-centered care, current innovations in health-care delivery show tentative promise to improve patient-centered communication and effective diabetes health care.