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327967
Prospective Exposure to the Elements of the Primary Care Medical Home Improve Patient Self-Management and Successful Coping with Type 2 Diabetes


Tuesday, November 3, 2015

Gregory D. Stevens, PhD, Departments of Family Medicine and Preventive Medicine, University of Southern California, Alhambra, CA
Leiyu Shi, PhD, Primary Care Policy Center for the Underserved, Johns Hopkins University, Baltimore, MD, MD
Christina Vane, MPH, Department of Family Medicine, University of Southern California Keck School of Medicine, Alhambra, CA
Nicole Pereira, Department of Health and Human Services, California State University of Los Angeles, Los Angeles, CA
Anne Peters, MD, Divison of Endocrinology, Keck School of Medicine of University of Southern California, Los Angeles, Los Angeles, CA
Purpose: To prospectively examine how short-term exposures to primary care delivered in various states of accordance with a medical home model was associated with changes in patient-reported coping and self-management activities among adults with type 2 diabetes.

Methods: Longitudinal study (two telephone interviews 6-months apart) of 464 patients with Medicaid insurance and type 2 diabetes in Los Angeles County.  The Primary Care Assessment Tool was used to measure seven features of medical home performance at both points in time.  Diabetes-related coping was assessed with a 10-item scale from the 2003 Health and Retirement Study.  Self-management was assessed using the Summary of Diabetes Self-Care Activities in four areas: diet, exercise, glucose monitoring and foot care.

Results:  Overall, we found that patients who reported receiving care from sites that function more like a medical home reported better coping and diabetes self-management. For example, a one-point difference on the total medical home score was associated with a 2.29 higher odds of reporting a high coping score (above the 66thpercentile), and 0.81 higher points (out of a 7 point scale) for the self-management score, after adjusting for the study covariates. Additionally, improvements over time in the total medical home score were associated with improvements in coping and overall self-management. For example, a one-point increase over six months in the total medical home score was associated with a 0.09-point improvement in coping and a 0.39-point increase in the overall self-management score. The medical home features of first contact care, longitudinality, and comprehensiveness were most strongly correlated with changes in coping and self-management.

Conclusion:  The Patient Centered Medical Home model appears to support better diabetes management.  Even changes in patient primary care experiences over a relatively short six-month period appear to have an affect on successful self-management of, and coping with, the disease.  Improvements in primary care delivery may directly affect patient outcomes.

Learning Areas:

Administer health education strategies, interventions and programs
Chronic disease management and prevention
Conduct evaluation related to programs, research, and other areas of practice
Public health or related research

Learning Objectives:
Assess the value of primary care for patients with diabetes or chronic disease.

Keyword(s): Diabetes, Primary Care

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have been a research assistant in a primary care and diabetes management study for a year. I have participated in data collection, analysis, and the production of the manuscript related to the study.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

Back to: 4195.0: Poster session: Medical homes