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Amanda Kelly ACF Abstract FY11

"Type II Diabetes Mellitus and the Patient-Provider Relationship"

Impact 2011-American Academy of Physician Assistants (AAPA)'s 39th Annual PA Conference

Amanda Kelly BS, PA-S, Tara Salas BA, PA-S, Scott Parrott BA, PA-S, Philip Baty MD, Theresa Bacon-Baguley PhD, RN

Purpose: According to the CDC 7.8% of the population have diabetes (CDC). Individuals with diabetes are at a higher risk for serious health complications which increase morbidity and mortality. Previous studies have confirmed that this morbidity and mortality can be reduced with effective medical care. More data is needed on the association between the patient-provider relationship and diabetic control. The purpose of this study is to evaluate the relationship between patient perceived empathy in the patient-provider relationship and diabetic control as measured by HbA1C.

Materials and Methods: Five-hundred subjects were randomly selected from a registry of over 6,000 diabetic patients from a mid-west multi-centered family practice. Inclusion criteria included: HbA1C value in the past one year, >18 years of age, and a diagnosis of Type 2 diabetes for at least one year. Information obtained through a computerized query included gender, recent HbA1C value, and information on the medical provider (name, credentials, gender and years of practice). Subjects were mailed the CARE survey, a validated tool used to assess empathy in the patient-provider relationship, along with a self addressed stamped envelope to return the survey to the researchers.

Results: 78 (16%) of the surveys were returned (eight surveys excluded because the subjects indicated Type 1 diabetes). 33 (47%) of the surveys were from males and 37 (53%) from females. Age range for males was 40 to 86 years(61 mean) and for females was 36 to 91 years(66 mean). Patient providers included: 36 MDs, and 4 DOs. Of the 40 patient providers, 31 were male and 9 were female. Male providers managed the care of 29(90%) of the male subjects and 21 (66%) of the female subjects, whereas, female providers managed the care of 3(10%) males and 11(34%) females. For all subjects HbA1C ranged from 5.3 to 12.4% (mean 6.9%). The range of HbA1C for males was 5.4 to 10.4 % (mean 7.0%) and for females was 5.3 to 12.4% (mean 6.9%). CARE survey scores ranged from 19 to 50 with a mean of 44.32 (a perfect score of 50 indicates an excellent empathy score). CARE survey scores were categorized into bivarate data, scores of >45 and scores <45. Linear regression of this data found CARE score to be a significant predictors of HbA1C value with the following: length of relationship (p=0.053), diabetes duration (p=0.022), length of provider practice (p=0.017), gender of provider (p<0.001), provider gender + patient age (p<0.001), and provider gender +diabetes duration (p=0.004). Further analysis identified a decrease in A1C with increased subject age, increase in A1C with increased diabetes duration and increase HbA1C (0.776%) in subjects having a female provider.

Conclusion: Overall the subjects who returned the CARE survey rated their provider with a high empathy score. Only when the CARE survey score was stratified by a great score (>45) and less than great score(<45) did we find predictors of HbA1C values. Other findings indicated that HbA1C is lower with increasing age, increased with diabetes duration and increased when cared for by a female provider.