CA6-02: Collaborative Goal Setting and HbA1c Control Among Patients With Diabetes.

Lafata JE, Dobie E, Morris H, Heisler M, Werner R, Divine G, Thomas A. CA6-02: Collaborative Goal Setting and HbA1c Control Among Patients With Diabetes. Clinical Medicine & Research. 2012 Aug 1; 10(3):160.

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Abstract:

Background/Aims Helping patients set and follow up on goals may be an effective way to help patients improve their confidence (self-efficacy) and commitment to improve diabetes self- management. We evaluate associations among patient-reported use of collaborative goal setting with clinicians, patient-reported self-efficacy, and clinical control (measured by HbA1c) among patients with diabetes. Methods A cohort of insured patients aged 18+ years with diabetes who initiated oral mono-therapy between 2000-2005 was surveyed in 2008. The survey included the 3 collaborative goal-setting items from the Patient Assessment of Chronic Illness Care (PACIC), a 4-item measure of self-efficacy, measures of socio-demographics, age of diabetes onset, and height/weight. Survey data were joined with automated laboratory and encounter data for the 12 months prior to and following survey administration. A structural equation model (SEM), using path analysis and adjusting for baseline patient characteristics (including HbA1c and diabetes-related co-morbidities and complications), was fit to investigate relationships among collaborative goal setting, self-efficacy and HbA1c control. Results Completed surveys were available for 1070 patients (n = 956 mail and n = 114 telephone; 77% response rate). Survey respondents were on average 68 years, half were female, 60% white, 31% black, and 57% reported low self-efficacy. On average, patients reported engaging in collaborative goal setting with their clinicians 'sometimes' (mean = 3.1, range 1 [never]-5 [always]). At baseline, mean HbA1c was 7.2%, with 22% = 8%. Results from the SEM did not support a direct relationship between the collaborative goal setting factor (Cronbach Alpha = 0.83) and HbA1c control, but did support an indirect relationship (asymmetric distribution of products 95% CI = -0.02, -0.002) with increases in collaborative goal setting positively associated with a greater likelihood of average or high self-efficacy (beta, p < 0.01), and average or high self-efficacy associated with lower follow-up HbA1cs level (-beta, p < 0.01). These relationships persisted after controlling for baseline HbA1c and other patient characteristics. Discussion While collaborative goal setting between patients with diabetes and their clinicians is not directly associated with better clinical control, it is associated with improved self-efficacy, which in turn, is associated with improved clinical control.