VA Study Examines Effects of Communication on Improving Hypertension Control in Diabetic Patients
HOUSTON – Researchers at the Michael E. DeBakey VA Medical Center (MEDVAMC) have found three doctor-patient communication factors that are significantly associated with blood pressure control in diabetes. The study, by Aanand D. Naik, M.D., Medical Care Line staff physician, Annette Walder, M.S., Research Care Line, Richard L. Street Jr., Ph.D., Research Care Line, and Michael A, Kallen, Ph.D., will appear in the March 18, 2008 issue of Circulation along with an accompanying editorial.
Uncontrolled high blood pressure is the primary risk factor for the cardiovascular complications of diabetes mellitus, such as heart attacks and strokes. Clinical trials have demonstrated reductions in cardiovascular deaths when blood pressure is lowered to controlled levels. Hypertension remains uncontrolled in more than half of all diabetics, including those receiving antihypertensive treatments. This study proposed that the quality of communication between doctors and patients may help overcome some of these barriers to hypertension control in routine diabetes care.
Naik and colleagues assessed particular characteristics of doctor-patient communication to determine their associations with hypertension control in diabetes care independent of patients’ clinical characteristics, medication adherence, and self-management behaviors. Three communication factors had significant associations with hypertension control. Two factors, patients’ preference for shared decision-making with their doctor and proactive communication with their doctor or nurse about abnormal results from home blood pressure monitoring, had independent, direct associations with hypertension control.
A third factor, collaborative communication by doctors when setting treatment goals, had an indirect effect on hypertension control. The impact of this factor was most apparent when a patient did not endorse a shared decision-making style. This study provides new evidence that doctor-patient communication can facilitate collaborative blood pressure goals and proactive recognition by patients of inadequate treatment. Collaborative communication during clinical encounters initiated by patients or doctors may improve rates of hypertension control in diabetes care independent of adherence to antihypertensive medications.
Naik believes doctor-patient communication is about more than patient satisfaction. “Patients play a powerful role in the effectiveness of treatments for chronic conditions like diabetes, and doctor-patient communication that establishes collaborative treatment goals and plans is instrumental in high quality diabetes care.”
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