Burden of Treatment in Diabetes Rarely Addressed

Chances to offer options to improve adherence, satisfaction often missed in office visits

WEDNESDAY, Jan. 4 (HealthDay News) -- Although the burden of diabetes treatments is discussed in more than 90 percent of primary care office visits, problem-solving efforts are made in only about one-third of cases, according to a study published in the January issue of Diabetes Care.

Krista Bohlen, Pharm.D., of the Mayo Clinic in Rochester, Minn., and colleagues used videographic analysis to evaluate whether patients with type 2 diabetes participating in a clinical trial discussed the high burden of treatment (BOT) with their clinicians and, if so, how these concerns were addressed. BOT was defined as treatment-related effects that limit the ability to participate in activities and tasks that are crucial to quality of life and that are not attributable to underlying disease. Two raters identified discussions in four separate domains, including access to timely, convenient, or affordable treatment; treatment administration concerns; unwanted or unintended consequences of treatment; and trouble monitoring the safe and effective use of the medication or following its ongoing effects.

The researchers found that, in videographic analysis of 46 primary care office visits, BOT was discussed in 93.5 percent of the visits. Patients initiated these discussions more than half the time (55 percent). As often as these discussions took place, however, the patient's BOT was only unambiguously addressed in 30 percent of cases, representing missed opportunities to address important issues that can affect patient adherence and satisfaction with diabetes treatments.

"Patients with diabetes routinely discuss BOT with clinicians but often with no effect. In the context of diabetes and other chronic diseases, this represents lost opportunities to offset preventable nonadherence, costs, and poorer quality of life for patients. As we progress toward providing minimally disruptive medicine, clinicians may need education on strategies for discussing and addressing BOT with patients," the authors write.

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