General practice management of type 2 diabetes


Patient-centred diabetes care
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☰ Table of contents


Recommendations

Reference

Grade*

A patient-centred communication style that incorporates patient preferences, assesses literacy and numeracy, and addresses cultural barriers to care should be used

19
American Diabetes Association, 2015

B

*Refer to Summary, explanation and source of recommendations for an explanation of the level of evidence and grade of evidence


Clinical context


How well a patient can read and use numbers has a significant impact on their ability to self-manage. Patients with diabetes and lower literacy or numeracy skills are at greater risk for poor diabetes outcomes.50

Many factors influence a person’s literacy and numeracy (eg socioeconomic status, cognitive function, culture). Health literacy is defined as an individual’s ability to read, perform basic numeracy skills, and understand and use healthcare information to make decisions and follow instructions for treatment.51 In 2006, the Australian Bureau of Statistics (ABS) identified that half of healthcare clients lacked sufficient health literacy to navigate the system.52 Importantly, this means that simply providing brochures and written information is not health education, and is unlikely to change health behaviour.

A patient’s health literacy typically improves through self-education and contact with health providers.53

 

In practice


A patient-centred consultation involves assessing a patient’s clinical signs and symptoms, as well as their thoughts, fears, preferences and expectations, and their social context. This ensures a complete understanding of the individual who is living with type 2 diabetes.

From a position of mutual understanding, management plans can then be developed with the patient, and tailored to specifically meet their needs, values and choices. Studies show that people with diabetes are more likely to engage actively in self management and achieve optimal health outcomes if plans are person-centred.54 Many of the assessments discussed in these guidelines are performed informally during a routine consultation. However, systems should be developed within the practice to allow appropriate assessment, review and management of individual patients.

Assess health literacy status

A patient’s literacy and numeracy skills affect their capacity for self management and what resources they will need. Literacy and numeracy skills are not always obvious, and GPs may worry that attempting to evaluate them will be uncomfortable for patients. The evidence in the literature does not support this concern.55

Organisations such as Diabetes Australia provide self-management education and support programs, peer support programs, mental health and diabetes programs, culturally and linguistically appropriate education, and information in several languages. They also have resources to help patients with low literacy skills.

Determine priorities for management

Discover what areas are affecting the patient’s quality of life in the context of comorbidities and life expectancy. Determine the management priorities, focusing on specific interventions (including those chosen by the patient) that have the most impact on the individual and will form the basis of their continuing care.

Encourage enrolment in structured programs

Structured diabetes care programs and evidence-based structured self-management training programs are available.
Refer to Appendix B. Structured patient-centred care plan – Examples of a General practice management and Patient care plan for a template of a General practice management plan (GPMP; structured patient-centred care plan).


Diabetes Australian and RACGP logo's
 
  1. Cavanaugh K, Wallston KA, Gebretsadik T, et al. Addressing literacy and numeracy to improve diabetes care: Two randomized controlled trials. Diabetes Care 2009;32(12):2149–55.
  2. Australian Bureau of Statistics. Health literacy, Australia. Report no. 4233.0. Canberra: ABS, 2006.  [Accessed 10 October 2013].
  3. Edwards SG, Thompson AJ, Playford ED. Integrated care pathways: Disease-specific or process-specific? Clin Med 2004;4(2):132–35.
  4. Silverman J, Kurtz SM, Drapper J. Skills for Communicating with Patients. 2nd edn. Oxford, UK: Radcliffe, 2005.
  5. White RO, Wolff K, Cavanaugh KL, Rothman R. Addressing health literacy and numeracy to improve diabetes education and care. Diabetes Spectr 2010;23(4):238–43.