Self-efficacy in diabetic care and occurrence of adverse events in an ambulatory setting

Abstract

Objective. To assess the relationship between patients' self-efficacy and the occurrence of adverse events in patients with insulinusing, type-2 diabetes mellitus in an ambulatory setting. Design. A prospective cohort study. Patients' risks were estimated by relative risk (RR) and analyzed by Poisson regression using the generalized estimating equation (GEE). Setting. Diabetic clinic at a university-affiliated, tertiary-care hospital in Bangkok, Thailand. Participants. One hundred and fifty-seven patients in the low self-efficacy group and 153 patients in the high self-efficacy group based on their pre-test scores, including self-efficacy in problem-solving and daily living. Main Outcome Measures. Adverse events defined as unplanned incidents related to medical management in diabetic care, leading to patient harm. Patient data were followed up every 3 months for 1 year. Results. The incident rate of adverse events in the low self-efficacy group was 2.12 incidents per 100 person-months, in comparison with 0.44 incidents per 100 person-months in the high self-efficacy group, resulting in adjusted RR of 4.75 (95% confidence interval (CI): 2.19-10.28). The use of long-acting insulin was also found to increase the risk of adverse events by 3.11 times (95% CI: 1.35-7.18) without interaction with patients' self-efficacies. Conclusion. To increase patients' self-efficacy by strengthening patient and family involvement may help prevent harmful events and improve patient safety in an ambulatory setting among chronically ill patients with type-2 diabetes mellitus. © The Author 2013. Published by Oxford University Press in association with the International Society for Quality in Health Care; all rights reserved.