Evaluation of provider documentation patterns as a tool to deliver ongoing patient‐centred diabetes education and support

Abstract

Background Diabetes mellitus (DM) is one of the most common chronic diseases in the world. As a disease with long‐term complications requiring changes in management, DM requires not only education at the time of diagnosis, but ongoing diabetes self‐management education and support (DSME/S). In the United States, however, only a small proportion of people with DM receive DSME/S, although evidence supports benefits of ongoing DSME/S. The diabetes education that providers deliver during follow‐up visits may be an important source for DSME/S for many people with DM. Methods We collected 200 clinic notes of follow‐up visits for 100 adults with DM and studied the History of Present Illness (HPI) and Impression and Plan (I&P) sections. Using a codebook based on the seven principles of American Association of Diabetes Educators Self‐Care Behaviors (AADE7), we conducted a multi‐step deductive thematic analysis to determine the patterns of DSME/S information occurrence in clinic notes. Additionally, we used the generalised linear mixed models for investigating whether providers delivered DSME/S to people with DM based on patient characteristics. Results During follow‐up visits, Monitoring was the most common self‐care behaviour mentioned in both HPI and I&P sections. Being Active was the least common self‐care behaviour mentioned in the HPI section and Healthy Coping was the least common self‐care behaviour mentioned in the I&P section. We found providers delivered more information on Healthy Eating to men compared to women in I&P section. Generally, providers delivered DSME/S to people with DM regardless of patient characteristics. Conclusions This study focused on the frequency distribution of information providers delivered to the people with DM during follow‐up clinic visits based on the AADE7. The results may indicate a lack of patient‐centred education when people with DM visit providers for ongoing management. Further studies are needed to identify the underlying reasons why providers have difficulty delivering patient‐centred education.

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Transforming AADE7 for Use in an Evaluation Framework for Health Information Technology in Diabetes Mellitus

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