Recall of provider instructions during a diabetes visit at a safety net clinic

Objectives: This project explored the patient-provider communication as it occurs among the diabetic patient population of Care Alliance in Cleveland, Ohio. This clinic provides care to the homeless population of Cleveland, Ohio. Hypothesizing that understanding provider instructions for the self-management of diabetes is a critical element in the prevention of diabetes morbidity, this study sought to understand the importance of effective communication. Methods: The project assessed what the providers tell the patients, what the patients recall being told, how well each party believes the information was understood, and key clinical outcomes including hemoglobin A1c values and change in hemoglobin A1c values. During a clinical visit, patients were observed and the instructions that were provided to patients by the health care provider were recorded. At the conclusion of the visit, the patients were interviewed as to the instructions that they recalled being given. The patients were also assessed on their knowledge of key lab values and familiarity with the disease process of diabetes. This study was a cross-sectional collection of data with a retrospective examination of prior hemoglobin A1c values in order to assess trends in diabetes management. Results: A total of 42 participants were interviewed. Patients were divided into two comparison groups: those who were able to recall all or most of the instructions that they were given and those who were unable to recall most of the instructions that they had been given. Results demonstrated a strong association between recall or instructions and successful management of diabetes as defined by a hemoglobin A1c value below 7 (p=0.003). Additionally, there was a correlation between older age and successful management of diabetes (p=0.0430) and a weak correlation between knowledge of most recent hemoglobin A¬1c value and successful management of diabetes (p=0.205). Conclusions: This study highlights the important role that recalling provider instructions may play in the process of effective management of diabetes. Particularly in a low health literacy population such as that seen at a homeless clinic, ensuring the patients are able to recall instructions is a critical step in the clinical encounter.