Presentation
PS9 - Making Patient Contextual Data Concrete: Examining the Overlap between Patient and Provider Conversations Regarding Type 2 Diabetes
DescriptionHealthcare does not end at the office door. Physicians or other healthcare providers are tasked with diagnosing and treating their patients accordingly. The patient must then complete several activities outside the healthcare office to manage their medical conditions or prevent future illnesses. Physicians must understand the demands of these activities and the factors that influence the patient’s ability to follow the treatment plan in order to assist the patient in effectively managing their health.
Patient-centered care (PCC) is defined as a partnership between patients and providers in order to ensure medical care reflects patient preferences and abilities, including factors which may affect the patient’s treatment adherence. This partnership puts patients at the center of their care team so that patients are properly educated on their condition and treatment options; it also ensures patients receive adequate support when choosing a treatment plan that meets their needs at the time they need and desire it. Thus, providers must understand not only the biomedical factors which may affect the treatment plan, but the contextual, or non-medical, factors in the patient’s life as well.
Non-medical contextual factors are those which directly or indirectly influence the patient’s health outcomes and quality of life. These include the social, physical, economic, and environmental factors of a patient’s life. There are many facets and models by which to characterize components these contextual factors such as social determinants of health (SDOH), contextual factors (identified through contextual red flags), and burden of treatment theory (BoT). Despite increased recognition of the importance of contextual factors, implementation of interventions to improve the incorporation of these factors into care have had varying degrees of success.
Understanding these contextual factors is particularly important for patients with type 2 diabetes, which is primarily self-managed by the patient outside the healthcare office. As of 2020, more than 37 million adults were diagnosed with diabetes in the United States. The risk of development and ability to self-manage diabetes are greatly influenced by non-medical contextual factors such as the patient’s diet, physical activity, and substance use, unlike other chronic health conditions which are more greatly influenced by physiological factors. Providers must understand incorporate contextual factors into their treatment plans which reflect the patient’s preferences and abilities to manage type 2 diabetes.
The need for effective tools to assist providers in collecting and managing contextual information increases as healthcare evolves to provide new medications and treatment options to support patients with chronic medical conditions. Development of these tools must begin with understanding the informational requirements of both patients and providers when discussing the management of type 2 diabetes.
Semi-structured interviews were conducted with patients and primary care providers to understand their experiences regarding conversations about contextual factors influencing the patient’s ability to self-manage their diabetes. Interview questions were developed by the researcher to capture a broad array of contextual factors affecting treatment adherence.
Five interviewers were conducted with patients living with type 2 diabetes (ages 34-74 years). All patients had received an initial diagnosis of type 2 diabetes or experienced a disease progression requiring the use of insulin within the past year. Thus, patients had recently had conversation with their care providers regarding their treatment plan. Eleven interviewers were conducted with providers treating patients with type 2 diabetes. Providers worked in a variety of roles ranging from primary care physicians and physician assistants to nurses and medical assistants and in a variety of healthcare clinics including private primary care offices, endocrinology offices, and hospitals. Providers had a minimum of five years of experience, including residency, and reported working regularly with patients with type 2 diabetes.
Interviews were completed over Zoom video conferencing; data was recorded through handwritten notes and video recordings of the interviews. Zoom conferencing provides an automatic transcription. These transcripts were reviewed for accuracy prior to analysis. Each interview was coded through inductive coding for emergent themes.
Six main overlapping these were identified from these interviews: (1) the patient’s emotional state, (2) access to community resources, (3) finances, (4) communication within the healthcare system, (5) health literacy, and (6) activities of daily life. The sub-themes and context within which these main themes were discussed varied between patients and providers. For example, both patients and providers both emphasized necessary lifestyle modifications such as diet. However, providers often focused on providing dietary recommendations and the influence of diet on the patient’s glucose and A1C whereas patients noted wanting a greater discussion on meal planning, access to healthy food options, and cultural differences influencing their diet.
Themes and sub-themes from these interviews will be examined for inclusion in Medly for Multiple Chronic Conditions (MCC). Medly is a smartphone-based telemonitoring program developed for heart failure management by the Center for Digital Therapeutics at the University Health Network (UHN). Medly was developed by a collaborative team of healthcare providers, researchers, and human factors experts to assist patients in managing their care. Medly integrates patient reported or collected data such as weight, blood pressure, heart rate, and symptoms, and provides self-care feedback to the patient based on their personalized thresholds and treatment plan set by the physician. Enrollment in the Medly Program, comprised of the Medly system described here and the Medly service, has improved patients’ physical and emotional heart-related quality of life and has resulted in increased patient self-care maintenance and management behaviors. Additional information on the development, implementation, statistics of use, and other publications on Medly can be found at medly.ca.
Medly MCC builds on the existing foundation of Medly to support patients with the management of other chronic conditions, including diabetes. Medly MCC is still under review. To support the expansion of Medly MCC for diabetes management, the authors intend to review the themes and sub-themes from interviews with patient and providers for their inclusion in Medly MCC. The study team intends to continue building upon these findings for iterative improvements to Medly MCC based on findings from within the application and subsequent research insights.
Patient-centered care (PCC) is defined as a partnership between patients and providers in order to ensure medical care reflects patient preferences and abilities, including factors which may affect the patient’s treatment adherence. This partnership puts patients at the center of their care team so that patients are properly educated on their condition and treatment options; it also ensures patients receive adequate support when choosing a treatment plan that meets their needs at the time they need and desire it. Thus, providers must understand not only the biomedical factors which may affect the treatment plan, but the contextual, or non-medical, factors in the patient’s life as well.
Non-medical contextual factors are those which directly or indirectly influence the patient’s health outcomes and quality of life. These include the social, physical, economic, and environmental factors of a patient’s life. There are many facets and models by which to characterize components these contextual factors such as social determinants of health (SDOH), contextual factors (identified through contextual red flags), and burden of treatment theory (BoT). Despite increased recognition of the importance of contextual factors, implementation of interventions to improve the incorporation of these factors into care have had varying degrees of success.
Understanding these contextual factors is particularly important for patients with type 2 diabetes, which is primarily self-managed by the patient outside the healthcare office. As of 2020, more than 37 million adults were diagnosed with diabetes in the United States. The risk of development and ability to self-manage diabetes are greatly influenced by non-medical contextual factors such as the patient’s diet, physical activity, and substance use, unlike other chronic health conditions which are more greatly influenced by physiological factors. Providers must understand incorporate contextual factors into their treatment plans which reflect the patient’s preferences and abilities to manage type 2 diabetes.
The need for effective tools to assist providers in collecting and managing contextual information increases as healthcare evolves to provide new medications and treatment options to support patients with chronic medical conditions. Development of these tools must begin with understanding the informational requirements of both patients and providers when discussing the management of type 2 diabetes.
Semi-structured interviews were conducted with patients and primary care providers to understand their experiences regarding conversations about contextual factors influencing the patient’s ability to self-manage their diabetes. Interview questions were developed by the researcher to capture a broad array of contextual factors affecting treatment adherence.
Five interviewers were conducted with patients living with type 2 diabetes (ages 34-74 years). All patients had received an initial diagnosis of type 2 diabetes or experienced a disease progression requiring the use of insulin within the past year. Thus, patients had recently had conversation with their care providers regarding their treatment plan. Eleven interviewers were conducted with providers treating patients with type 2 diabetes. Providers worked in a variety of roles ranging from primary care physicians and physician assistants to nurses and medical assistants and in a variety of healthcare clinics including private primary care offices, endocrinology offices, and hospitals. Providers had a minimum of five years of experience, including residency, and reported working regularly with patients with type 2 diabetes.
Interviews were completed over Zoom video conferencing; data was recorded through handwritten notes and video recordings of the interviews. Zoom conferencing provides an automatic transcription. These transcripts were reviewed for accuracy prior to analysis. Each interview was coded through inductive coding for emergent themes.
Six main overlapping these were identified from these interviews: (1) the patient’s emotional state, (2) access to community resources, (3) finances, (4) communication within the healthcare system, (5) health literacy, and (6) activities of daily life. The sub-themes and context within which these main themes were discussed varied between patients and providers. For example, both patients and providers both emphasized necessary lifestyle modifications such as diet. However, providers often focused on providing dietary recommendations and the influence of diet on the patient’s glucose and A1C whereas patients noted wanting a greater discussion on meal planning, access to healthy food options, and cultural differences influencing their diet.
Themes and sub-themes from these interviews will be examined for inclusion in Medly for Multiple Chronic Conditions (MCC). Medly is a smartphone-based telemonitoring program developed for heart failure management by the Center for Digital Therapeutics at the University Health Network (UHN). Medly was developed by a collaborative team of healthcare providers, researchers, and human factors experts to assist patients in managing their care. Medly integrates patient reported or collected data such as weight, blood pressure, heart rate, and symptoms, and provides self-care feedback to the patient based on their personalized thresholds and treatment plan set by the physician. Enrollment in the Medly Program, comprised of the Medly system described here and the Medly service, has improved patients’ physical and emotional heart-related quality of life and has resulted in increased patient self-care maintenance and management behaviors. Additional information on the development, implementation, statistics of use, and other publications on Medly can be found at medly.ca.
Medly MCC builds on the existing foundation of Medly to support patients with the management of other chronic conditions, including diabetes. Medly MCC is still under review. To support the expansion of Medly MCC for diabetes management, the authors intend to review the themes and sub-themes from interviews with patient and providers for their inclusion in Medly MCC. The study team intends to continue building upon these findings for iterative improvements to Medly MCC based on findings from within the application and subsequent research insights.
Event Type
Poster Presentation
TimeTuesday, March 264:45pm - 6:15pm CDT
LocationSalon C
Digital Health
Simulation and Education
Hospital Environments
Medical and Drug Delivery Devices
Patient Safety Research and Initiatives