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Glucose control, self-care behaviors, and the presence of the chronic care model in primary care clinics.
Diabetes Care. 2007 Nov; 30(11):2849-54.DC

Abstract

OBJECTIVE

The purpose of this study was to examine the relationship between A1C and the extent to which care delivered to patients with type 2 diabetes in primary care clinics is consistent with the chronic care model (CCM), after controlling for self-care behaviors.

RESEARCH DESIGN AND METHODS

This was a cross-sectional, observational study of care provided to 618 patients with type 2 diabetes across 20 small, autonomous primary care clinics in South Texas. Subjects completed an exit survey. The medical record was abstracted for A1C values. Clinicians completed the Assessment of Chronic Illness Care (ACIC) survey, a validated measure of the extent to which care delivered is consistent with the CCM.

RESULTS

There was a significant relationship between ACIC score and A1C, but this relationship varied according to self-care behavior for exercise and was strongest for those who did not adhere to exercise recommendations: for every 1-point increase in ACIC score, A1C was 0.144% lower (P < 0.001). The relationship between ACIC score and A1C for those who adhered to their diet was similar to that for those who did not, after adjusting for exercise, but the overall level of control was better for those who adhered to their diet.

CONCLUSIONS

Characteristics of the primary care clinic where one receives care are an important predictor of glucose control. If resources for implementing the CCM are limited, one might want to focus on clinics with low ACIC scores that serve a population of patients who are sedentary because this population may be likely to realize the most benefit from improved glucose control.

Authors+Show Affiliations

Department of Family & Community Medicine/University of Texas Health Science Center-San Antonio, San Antonio, Texas, USA. parchman@uthscsa.eduNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Multicenter Study
Research Support, U.S. Gov't, Non-P.H.S.
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

17682121

Citation

Parchman, Michael L., et al. "Glucose Control, Self-care Behaviors, and the Presence of the Chronic Care Model in Primary Care Clinics." Diabetes Care, vol. 30, no. 11, 2007, pp. 2849-54.
Parchman ML, Pugh JA, Wang CP, et al. Glucose control, self-care behaviors, and the presence of the chronic care model in primary care clinics. Diabetes Care. 2007;30(11):2849-54.
Parchman, M. L., Pugh, J. A., Wang, C. P., & Romero, R. L. (2007). Glucose control, self-care behaviors, and the presence of the chronic care model in primary care clinics. Diabetes Care, 30(11), 2849-54.
Parchman ML, et al. Glucose Control, Self-care Behaviors, and the Presence of the Chronic Care Model in Primary Care Clinics. Diabetes Care. 2007;30(11):2849-54. PubMed PMID: 17682121.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Glucose control, self-care behaviors, and the presence of the chronic care model in primary care clinics. AU - Parchman,Michael L, AU - Pugh,Jacqueline A, AU - Wang,Chen-Pin, AU - Romero,Raquel L, Y1 - 2007/08/06/ PY - 2007/8/8/pubmed PY - 2007/12/15/medline PY - 2007/8/8/entrez SP - 2849 EP - 54 JF - Diabetes care JO - Diabetes Care VL - 30 IS - 11 N2 - OBJECTIVE: The purpose of this study was to examine the relationship between A1C and the extent to which care delivered to patients with type 2 diabetes in primary care clinics is consistent with the chronic care model (CCM), after controlling for self-care behaviors. RESEARCH DESIGN AND METHODS: This was a cross-sectional, observational study of care provided to 618 patients with type 2 diabetes across 20 small, autonomous primary care clinics in South Texas. Subjects completed an exit survey. The medical record was abstracted for A1C values. Clinicians completed the Assessment of Chronic Illness Care (ACIC) survey, a validated measure of the extent to which care delivered is consistent with the CCM. RESULTS: There was a significant relationship between ACIC score and A1C, but this relationship varied according to self-care behavior for exercise and was strongest for those who did not adhere to exercise recommendations: for every 1-point increase in ACIC score, A1C was 0.144% lower (P < 0.001). The relationship between ACIC score and A1C for those who adhered to their diet was similar to that for those who did not, after adjusting for exercise, but the overall level of control was better for those who adhered to their diet. CONCLUSIONS: Characteristics of the primary care clinic where one receives care are an important predictor of glucose control. If resources for implementing the CCM are limited, one might want to focus on clinics with low ACIC scores that serve a population of patients who are sedentary because this population may be likely to realize the most benefit from improved glucose control. SN - 1935-5548 UR - https://www.unboundmedicine.com/medline/citation/17682121/Glucose_control_self_care_behaviors_and_the_presence_of_the_chronic_care_model_in_primary_care_clinics_ L2 - http://care.diabetesjournals.org/cgi/pmidlookup?view=long&amp;pmid=17682121 DB - PRIME DP - Unbound Medicine ER -