July 11, 2013

This Is Very Sad for Patients

Even though this is a study done in the UK, the question that needs to be asked is “why?”. The title could even be applied to the US. The title of the article is “Clinical Support for Patient Self-Management Is Rhetoric Rather Than Reality, Experts Say.” Unfortunately, the support for patients is even worse in the USA when it involves patients with diabetes. In the USA we have diabetes “experts” that believe that the A1c done quarterly is sufficient. From the American Diabetes Association to the Joslin Diabetes Center, these “experts” spew forth their ignorance.

Those with type 1 diabetes generally receive more education that most type 2 people with diabetes, and rightfully so. Those of us type 2 and using insulin receive more education than type 2 patients not on insulin do. Self-management education is supposed to increase the patient's ability to take ownership of their diabetes and often to self treat their condition. With the current medical healthcare crisis, this would seem prudent to insure the sustainability of health services in terms of cost.

Bringing self-management support discussions and decisions into everyday clinical practices should encourage patients to become more actively involved. Yet, we see example after example in articles where doctors are hesitant to prescribe insulin and use the fear factor to promote stacking of oral medications. As a result, diabetes often becomes progressive and the complications become part of life. In many ways, it is the patients that read blogs like this and go on a mission to educate himself or herself. Some are capable of making the necessary lifestyle changes and need to make many changes. Others have only a few changes to make as expressed in this blog.

In the study, 44 practices were trained in the new self-management approach. This training program was developed by the universities involved in the study and was to help the practices put the patient at the center of their care. It was also to use a range of self-management support resources. More than 5500 patients, one of the largest randomized controlled trials ever completed, were divided into two groups. Even the practices were randomized to receive the training or deliver routine care. Those practices providing routine care were trained after the trial was completed.

Now for the sad part. “Feedback and assessments showed that while practices engaged with and enjoyed the training, they did not use the approach to improve shared decision-making with patients or encourage the take-up of self-management support. There was no difference in results for any patient outcomes or on service use between the group that had the self-management approach and the group which received usual care.”

The comments by the authors really shed no insights into the failure of this study and they are working to analyze the data further. These comments range from adding additional incentives to encourage practices to engage with a self-management agenda, to most forms of intervention fail to embed themselves into the everyday lives of the patients.

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