Diabetes Patients, Physicians Differ on Priorities

Major Finding: Sixty percent of patient-physician pairs studied agreed on the patient's top three health priorities; 29% of the the pairs had no matches in the top three priorities.

Data Source: Prospective cohort study of 92 primary care providers and 1,169 of their diabetic patients with comorbid hypertension.

Disclosures: The study was supported by the Robert Wood Johnson Clinical Scholars Program. The authors reported having no financial disclosures.

Diabetes patients with multiple health concerns are not always in sync with their physicians regarding the relative importance of specific comorbidities, and this incongruity could have clinical management implications, according to a report by University of Michigan researchers.

In a prospective cohort study designed to assess concordance of patient and physician priorities, Dr. Donna M. Zulman and her colleagues at the university in Ann Arbor surveyed 92 primary care providers and 1,169 of their diabetes patients. Patients ranked their most important health concerns and providers ranked the most important conditions likely to affect the patients' health outcomes. For 60% of the patient-provider pairs, concordance was high: The provider ranked the same top three health concerns as did the patient, or ranked two of the same health concerns, and these two matched the patient's most important concerns. For 72% of the patient-provider pairs, the patient's most important concern was on the provider's top-three list, but 16% of the pairs had three matching health concerns, 55% had two, 25% had one, and 4% had none, they wrote (J. Gen. Intern. Med. 2010 Feb. 2 [Epub doi: 10.1007/s11606-009-1232-1]).

The discordance in perception of hypertension as the most important comorbidity was especially notable. “Although providers ranked hypertension as the most important health condition for 384 (38%) patients, only 184 (18%) patients listed hypertension as their most important health concern,” they wrote. “Patients were more likely than providers to list 'losing weight or being more active' in their top three concerns (35% vs. 21%, respectively).” This finding is consistent with previous data suggesting that many diabetic patients are not aware of the importance of blood pressure control despite the available evidence and clinical guidelines, the authors said.

Another striking disconnect was observed in patients who listed pain or depression as their top health concern relative to the number of their providers who ranked these conditions as likely to affect health outcomes. For example, 9% of patients who listed pain as their top health concern had a provider who ranked it among the top three, and 32% who listed depression as their most important comorbidity had physicians who agreed. “This discordance is concerning, not only because it raises the possibility that providers are unaware of the extent to which these conditions affect their patients, but also because pain and depression can be barriers to effective diabetes self-management, and (in the case of depression) may worsen glycemic control and increase the risk of mortality,” the authors noted. “By deemphasizing symptomatic conditions, providers are actually neglecting some of the most important medical concerns that are likely to affect health outcomes in these patients.”

Study limitations included the inability of the concordance score to measure the concept of which conditions the providers thought the patients would prioritize, and the fact that the patients and providers were aware that the study was looking at diabetic patients with an elevated blood pressure level at triage, thus making it more likely that hypertension and diabetes would be listed among the top three health concerns and potentially hindering the evaluation of concordance patterns among other health conditions, the authors wrote.

The findings “reinforce the need for heightened provider recognition of patients' symptomatic conditions as well as their non-health competing demands.”

Major Finding: Sixty percent of patient-physician pairs studied agreed on the patient's top three health priorities; 29% of the the pairs had no matches in the top three priorities.

Data Source: Prospective cohort study of 92 primary care providers and 1,169 of their diabetic patients with comorbid hypertension.

Disclosures: The study was supported by the Robert Wood Johnson Clinical Scholars Program. The authors reported having no financial disclosures.

Diabetes patients with multiple health concerns are not always in sync with their physicians regarding the relative importance of specific comorbidities, and this incongruity could have clinical management implications, according to a report by University of Michigan researchers.

In a prospective cohort study designed to assess concordance of patient and physician priorities, Dr. Donna M. Zulman and her colleagues at the university in Ann Arbor surveyed 92 primary care providers and 1,169 of their diabetes patients. Patients ranked their most important health concerns and providers ranked the most important conditions likely to affect the patients' health outcomes. For 60% of the patient-provider pairs, concordance was high: The provider ranked the same top three health concerns as did the patient, or ranked two of the same health concerns, and these two matched the patient's most important concerns. For 72% of the patient-provider pairs, the patient's most important concern was on the provider's top-three list, but 16% of the pairs had three matching health concerns, 55% had two, 25% had one, and 4% had none, they wrote (J. Gen. Intern. Med. 2010 Feb. 2 [Epub doi: 10.1007/s11606-009-1232-1]).

The discordance in perception of hypertension as the most important comorbidity was especially notable. “Although providers ranked hypertension as the most important health condition for 384 (38%) patients, only 184 (18%) patients listed hypertension as their most important health concern,” they wrote. “Patients were more likely than providers to list 'losing weight or being more active' in their top three concerns (35% vs. 21%, respectively).” This finding is consistent with previous data suggesting that many diabetic patients are not aware of the importance of blood pressure control despite the available evidence and clinical guidelines, the authors said.

Another striking disconnect was observed in patients who listed pain or depression as their top health concern relative to the number of their providers who ranked these conditions as likely to affect health outcomes. For example, 9% of patients who listed pain as their top health concern had a provider who ranked it among the top three, and 32% who listed depression as their most important comorbidity had physicians who agreed. “This discordance is concerning, not only because it raises the possibility that providers are unaware of the extent to which these conditions affect their patients, but also because pain and depression can be barriers to effective diabetes self-management, and (in the case of depression) may worsen glycemic control and increase the risk of mortality,” the authors noted. “By deemphasizing symptomatic conditions, providers are actually neglecting some of the most important medical concerns that are likely to affect health outcomes in these patients.”

Study limitations included the inability of the concordance score to measure the concept of which conditions the providers thought the patients would prioritize, and the fact that the patients and providers were aware that the study was looking at diabetic patients with an elevated blood pressure level at triage, thus making it more likely that hypertension and diabetes would be listed among the top three health concerns and potentially hindering the evaluation of concordance patterns among other health conditions, the authors wrote.

The findings “reinforce the need for heightened provider recognition of patients' symptomatic conditions as well as their non-health competing demands.”

Major Finding: Sixty percent of patient-physician pairs studied agreed on the patient's top three health priorities; 29% of the the pairs had no matches in the top three priorities.

Data Source: Prospective cohort study of 92 primary care providers and 1,169 of their diabetic patients with comorbid hypertension.

Disclosures: The study was supported by the Robert Wood Johnson Clinical Scholars Program. The authors reported having no financial disclosures.

Diabetes patients with multiple health concerns are not always in sync with their physicians regarding the relative importance of specific comorbidities, and this incongruity could have clinical management implications, according to a report by University of Michigan researchers.

In a prospective cohort study designed to assess concordance of patient and physician priorities, Dr. Donna M. Zulman and her colleagues at the university in Ann Arbor surveyed 92 primary care providers and 1,169 of their diabetes patients. Patients ranked their most important health concerns and providers ranked the most important conditions likely to affect the patients' health outcomes. For 60% of the patient-provider pairs, concordance was high: The provider ranked the same top three health concerns as did the patient, or ranked two of the same health concerns, and these two matched the patient's most important concerns. For 72% of the patient-provider pairs, the patient's most important concern was on the provider's top-three list, but 16% of the pairs had three matching health concerns, 55% had two, 25% had one, and 4% had none, they wrote (J. Gen. Intern. Med. 2010 Feb. 2 [Epub doi: 10.1007/s11606-009-1232-1]).

The discordance in perception of hypertension as the most important comorbidity was especially notable. “Although providers ranked hypertension as the most important health condition for 384 (38%) patients, only 184 (18%) patients listed hypertension as their most important health concern,” they wrote. “Patients were more likely than providers to list 'losing weight or being more active' in their top three concerns (35% vs. 21%, respectively).” This finding is consistent with previous data suggesting that many diabetic patients are not aware of the importance of blood pressure control despite the available evidence and clinical guidelines, the authors said.

Another striking disconnect was observed in patients who listed pain or depression as their top health concern relative to the number of their providers who ranked these conditions as likely to affect health outcomes. For example, 9% of patients who listed pain as their top health concern had a provider who ranked it among the top three, and 32% who listed depression as their most important comorbidity had physicians who agreed. “This discordance is concerning, not only because it raises the possibility that providers are unaware of the extent to which these conditions affect their patients, but also because pain and depression can be barriers to effective diabetes self-management, and (in the case of depression) may worsen glycemic control and increase the risk of mortality,” the authors noted. “By deemphasizing symptomatic conditions, providers are actually neglecting some of the most important medical concerns that are likely to affect health outcomes in these patients.”

Study limitations included the inability of the concordance score to measure the concept of which conditions the providers thought the patients would prioritize, and the fact that the patients and providers were aware that the study was looking at diabetic patients with an elevated blood pressure level at triage, thus making it more likely that hypertension and diabetes would be listed among the top three health concerns and potentially hindering the evaluation of concordance patterns among other health conditions, the authors wrote.

The findings “reinforce the need for heightened provider recognition of patients' symptomatic conditions as well as their non-health competing demands.”