Research ArticleOriginal Research

Examining Variations in Action Plan Quality Among Adults With Type 2 Diabetes in Primary Care

Pernille H. Kjaer, Lawrence Fisher, Michael B. Potter, Mansi Dedhia, José Parra, Niels Ejskjaer, Søren Skovlund and Danielle Hessler
The Journal of the American Board of Family Medicine May 2021, 34 (3) 608-617; DOI: https://doi.org/10.3122/jabfm.2021.03.200285

References

  1. 1.↵
    1. Hessler DM,
    2. Fisher L,
    3. Bowyer V,
    4. et al
    . Self-management support for chronic disease in primary care: frequency of patient self-management problems and patient-reported priorities, and alignment with ultimate behavior goal selection. BMC Fam Pract 2019;20:120120.
    OpenUrl
  2. 2.↵
    1. Wagner EH,
    2. Austin BT,
    3. Von Korff M
    . Improving outcomes in chronic illness. Manag Care Q 1996;4:12–25.
    OpenUrlPubMed
  3. 3.↵
    1. Wagner EH,
    2. Austin BT,
    3. Von Korff M
    . Organizing care for patients with chronic illness. Milbank Q 1996;74:511–44.
    OpenUrlCrossRefPubMedWeb of Science
  4. 4.↵
    1. Bodenheimer T,
    2. Wagner EH,
    3. Grumbach K
    . Improving primary care for patients with chronic illness. JAMA 2002;288:1775–9.
    OpenUrlCrossRefPubMedWeb of Science
  5. 5.↵
    1. Bodenheimer T,
    2. Wagner EH,
    3. Grumbach K
    . Improving primary care for patients with chronic illness: the chronic care model, Part 2. JAMA 2002;288:1909–14.
    OpenUrlCrossRefPubMedWeb of Science
  6. 6.↵
    1. Berenson RA,
    2. Hammons T,
    3. Gans DN,
    4. et al
    . A house is not a home: keeping patients at the center of practice redesign. Health Aff (Millwood) 2008;27:1219–30.
    OpenUrlAbstract/FREE Full Text
  7. 7.↵
    1. Tuerk PW,
    2. Mueller M,
    3. Egede LE
    . Estimating physician effects on glycemic control in the treatment of diabetes: methods, effects sizes, and implications for treatment policy. Diabetes Care 2008;31:869–73.
    OpenUrlAbstract/FREE Full Text
  8. 8.↵
    1. Young-Hyman D,
    2. Groot M,
    3. de Hill-Briggs F,
    4. et al
    . Psychosocial care for people with diabetes: a position statement of the american diabetes association. Diabetes Care 2016;39:2126–40.
    OpenUrlFREE Full Text
  9. 9.↵
    1. Fisher L,
    2. Skaff MM,
    3. Mullan JT,
    4. Arean P,
    5. Glasgow R,
    6. Masharani U
    . A longitudinal study of affective and anxiety disorders, depressive affect and diabetes distress in adults with Type 2 diabetes. Diabet Med J Med 2008;25:1096–101.
    OpenUrl
  10. 10.↵
    1. Fisher L,
    2. Mullan JT,
    3. Arean P,
    4. Glasgow RE,
    5. Hessler D,
    6. Masharani U
    . Diabetes distress but not clinical depression or depressive symptoms is associated with glycemic control in both cross-sectional and longitudinal analyses. Diabetes Care 2010;33:23–8.
    OpenUrlAbstract/FREE Full Text
  11. 11.↵
    1. Funnell MM,
    2. Tang TS,
    3. Anderson RM
    . From DSME to DSMS: developing empowerment-based diabetes self-management support. Diabetes Spectrum 2007; 20: 221–6. doi:10.2337/diaspect.20.4.221.
    OpenUrlAbstract/FREE Full Text
  12. 12.↵
    1. Naik AD,
    2. Hundt NE,
    3. Vaughan EM,
    4. et al
    . Effect of telephone-delivered collaborative goal setting and behavioral activation vs enhanced usual care for depression among adults with uncontrolled diabetes: a randomized clinical trial. JAMA Netw Open 2019;2:e198634.
    OpenUrl
  13. 13.↵
    1. DeWalt DA,
    2. Davis TC,
    3. Wallace AS,
    4. et al
    . Goal setting in diabetes self-management: taking the baby steps to success. Patient Educ Couns 2009;77:218–23.
    OpenUrlCrossRefPubMedWeb of Science
  14. 14.↵
    1. Bodenheimer T,
    2. Davis C,
    3. Holman H
    . Helping patients adopt healthier behaviors. Clin Diabetes 2007;25:66–70.
    OpenUrlFREE Full Text
  15. 15.↵
    1. Dickinson WP,
    2. Dickinson LM,
    3. Jortberg BT,
    4. et al
    . A cluster randomized trial comparing strategies for translating self-management support into primary care practices. J Am Board Fam Med J Am Board Fam Med 2019;32:341–52.
    OpenUrl
  16. 16.↵
    1. Thom DH,
    2. Willard-Grace R,
    3. Hessler D,
    4. et al
    . The impact of health coaching on medication adherence in patients with poorly controlled diabetes, hypertension, and/or hyperlipidemia: a randomized controlled trial. J Am Board Fam Med 2015;28:38–45.
    OpenUrlAbstract/FREE Full Text
  17. 17.↵
    1. Thom DH,
    2. Ghorob A,
    3. Hessler D,
    4. Vore DD,
    5. Chen E,
    6. Bodenheimer TA
    . Impact of peer health coaching on glycemic control in low-income patients with diabetes: a randomized controlled trial. Ann Fam Med 2013;11:137–44.
    OpenUrlAbstract/FREE Full Text
  18. 18.↵
    1. Chen R-Y,
    2. Huang L-C,
    3. Su C-T,
    4. et al
    . Effectiveness of short-term health coaching on diabetes control and self-management efficacy: a quasi-experimental trial. Front Public Health 2019;7:314.
    OpenUrl
  19. 19.↵
    1. MacGregor K,
    2. Handley M,
    3. Wong S,
    4. et al
    . Behavior-change action plans in primary care: a feasibility study of clinicians. J Am Board Fam Med 2006;19:215–23
    OpenUrlAbstract/FREE Full Text
  20. 20.↵
    1. Riley KM,
    2. Glasgow RE,
    3. Eakin EG
    . Resources for health: a social-ecological intervention for supporting self-management of chronic conditions. J Health Psychol 2001;6:693–705.
    OpenUrlCrossRefPubMedWeb of Science
  21. 21.↵
    1. Skovlund SE,
    2. Lichtenberg TH,
    3. Hessler D,
    4. Ejskjaer N
    . Can the routine use of patient-reported outcome measures improve the delivery of person-centered diabetes care? a review of recent developments and a case study. Curr Diab Rep 2019;19:84.
    OpenUrl
  22. 22.↵
    1. Fisher L,
    2. Hessler D,
    3. Masharani U,
    4. Strycker L
    . Impact of baseline patient characteristics on interventions to reduce diabetes distress: the role of personal conscientiousness and diabetes self-efficacy. Diabet Med J Med 2014;31:739–46.
    OpenUrl
  23. 23.↵
    1. Hessler D,
    2. Bowyer V,
    3. Gold R,
    4. Shields-Zeeman L,
    5. Cottrell E,
    6. Gottlieb LM
    . Bringing social context into diabetes care: intervening on social risks versus providing contextualized care. Curr Diab Rep 2019;19:30. doi:10.1007/s11892-019-1149-y
    OpenUrlCrossRefPubMed
  24. 24.↵
    1. Glynn RJ,
    2. Brookhart MA,
    3. Stedman M,
    4. Avorn J,
    5. Solomon DH
    . Design of cluster-randomized trials of quality improvement interventions aimed at medical care providers. Med Care 2007;45:S38–43.
    OpenUrlCrossRefPubMedWeb of Science
  25. 25.↵
    1. Raab GM,
    2. Butcher I
    . Balance in cluster randomized trials. Statist Med 2001;20:351–65.
    OpenUrl
  26. 26.↵
    1. Kraschnewski JL,
    2. Keyserling TC,
    3. Bangdiwala SI,
    4. et al
    . Optimized probability sampling of study sites to improve generalizability in a multisite intervention trial. Prev Chronic Dis 2010;7:A10.
    OpenUrlPubMed
  27. 27.↵
    1. Moulton LH
    . Covariate-based constrained randomization of group-randomized trials. Clin Trials Lond Trials 2004;1:297–305.
    OpenUrl
  28. 28.↵
    1. Chaudhary MA,
    2. Moulton LH
    . A SAS macro for constrained randomization of group-randomized designs. Comput Methods Programs Biomed 2006;83:205–10.
    OpenUrlCrossRefPubMed
  29. 29.↵
    San Francisco Bay Area Collaborative Research Network (SFBayCRN). CTSI Research Consultation. Available from: https://consult.ucsf.edu/sfbaycrn. Accessed April 20, 2020.
  30. 30.↵
    1. Wallace LS,
    2. Rogers ES,
    3. Roskos SE,
    4. Holiday DB,
    5. Weiss BD
    . Brief report: screening items to identify patients with limited health literacy skills. J Gen Intern Med 2006;21:874–7.
    OpenUrlCrossRefPubMedWeb of Science
  31. 31.↵
    1. Kroenke K,
    2. Spitzer RL,
    3. Williams JBW
    . The Patient Health Questionnaire-2: validity of a two-item depression screener. Med Care 2003;41:1284–92.
    OpenUrlCrossRefPubMedWeb of Science
  32. 32.↵
    1. Kroenke K,
    2. Strine TW,
    3. Spitzer RL,
    4. Williams JBW,
    5. Berry JT,
    6. Mokdad AH
    . The PHQ-8 as a measure of current depression in the general population. J Affect Disord 2009;114:163–73.
    OpenUrlCrossRefPubMedWeb of Science
  33. 33.↵
    1. Polonsky WH,
    2. Fisher L,
    3. Earles J,
    4. et al
    . Assessing psychosocial distress in diabetes: development of the diabetes distress scale. Diabetes Care 2005;28:626–31.
    OpenUrlAbstract/FREE Full Text
  34. 34.↵
    1. Fisher L,
    2. Glasgow RE,
    3. Mullan JT,
    4. Skaff MM,
    5. Polonsky WH
    . Development of a brief diabetes distress screening instrument. Ann Fam Med 2008;6:246–52.
    OpenUrlAbstract/FREE Full Text
  35. 35.↵
    1. Pearlin LI,
    2. Lieberman MA,
    3. Menaghan EG,
    4. Mullan JT
    . The stress process. J Health Soc Behav 1981;22:337–56.
    OpenUrlCrossRefPubMedWeb of Science
  36. 36.↵
    1. Gottlieb LM,
    2. Hessler D,
    3. Long D,
    4. et al
    . Effects of social needs screening and in-person service navigation on child health: a randomized clinical trial. JAMA Pediatr 2016;170:e162521.
    OpenUrl
  37. 37.↵
    1. Gottlieb L,
    2. Hessler D,
    3. Long D,
    4. Amaya A,
    5. Adler N
    . A randomized trial on screening for social determinants of health: the iScreen study. Pediatrics 2014;134:e1611–18.
    OpenUrlAbstract/FREE Full Text
  38. 38.↵
    1. Gottlieb LM,
    2. Adler NE,
    3. Wing H,
    4. et al
    . Effects of in-person assistance vs personalized written resources about social services on household social risks and child and caregiver health: a randomized clinical trial. JAMA Netw Open 2020;3:e200701.
    OpenUrl
  39. 39.↵
    Centers for Disease Control and Prevention. What We Eat in America, NHANES 2005–2006: Usual nutrient intakes from food and water compared to 1997 Dietary Reference Intakes for Vitamin D, Calcium, Phosphorous, and Magnesium. Available from: https://www.ars.usda.gov/ARSUserFiles/80400530/pdf/0506/usual_nutrient_intake_vitD_ca_phos_mg_2005-06.pdf. Accessed April 3, 2020.
  40. 40.↵
    1. Toobert DJ,
    2. Hampson SE,
    3. Glasgow RE
    . The summary of diabetes self-care activities measure: results from 7 studies and a revised scale. Diabetes Care 2000;23:943–50.
    OpenUrlAbstract
  41. 41.↵
    1. Jilcott SB,
    2. Keyserling TC,
    3. Samuel-Hodge CD,
    4. Johnston LF,
    5. Gross MD,
    6. Ammerman AS
    . Validation of a brief dietary assessment to guide counseling for cardiovascular disease risk reduction in an underserved population. J Am Diet Assoc 2007;107:246–55.
    OpenUrlCrossRefPubMedWeb of Science
  42. 42.↵
    1. Craig CL,
    2. Marshall AL,
    3. Sjöström M,
    4. et al
    . International physical activity questionnaire: 12-country reliability and validity. Med Sci Sports Exerc 2003;35:1381–95.
    OpenUrlCrossRefPubMedWeb of Science
  43. 43.↵
    1. Bender BG,
    2. Bartlett SJ,
    3. Rand CS,
    4. Turner C,
    5. Wamboldt FS,
    6. Zhang L
    . Impact of interview mode on accuracy of child and parent report of adherence with asthma-controller medication. Pediatrics 2007;120:e471–77.
    OpenUrlAbstract/FREE Full Text
  44. 44.↵
    1. Bender BG,
    2. Rankin A,
    3. Tran ZV,
    4. Wamboldt FS
    . Brief-interval telephone surveys of medication adherence and asthma symptoms in the Childhood Asthma Management Program Continuation Study. Ann Allergy Asthma Immunol Off Publ Am Coll Allergy Asthma Immunol 2008;101:382–6.
    OpenUrl
  45. 45.↵
    1. Horne R,
    2. Weinman J
    . Patients' beliefs about prescribed medicines and their role in adherence to treatment in chronic physical illness. J Psychosom Res 1999;47:555–67.
    OpenUrlCrossRefPubMedWeb of Science
  46. 46.↵
    Centers for Disease Control and Prevention. Behavioral Risk Factor Surveillance System State Questionnaire. Available from: https://www.cdc.gov/brfss/questionnaires/pdf-ques/2004brfss.pdf.
  47. 47.↵
    1. Ory MG,
    2. Jordan PJ,
    3. Bazzarre T
    . The Behavior Change Consortium: setting the stage for a new century of health behavior-change research. Health Educ Res 2002;17:500–11.
    OpenUrlCrossRefPubMedWeb of Science
  48. 48.↵
    Health.gov. 2015–2020 Dietary Guidelines. Available from: https://health.gov/our-work/food-nutrition/2015-2020-dietary-guidelines/guidelines/. Accessed April 3, 2020.
  49. 49.↵
    1. Dawson DA,
    2. Grant BF,
    3. Li T-K
    . Quantifying the risks associated with exceeding recommended drinking limits. Alcohol Clin Exp Res 2005;29:902–8.
    OpenUrlCrossRefPubMedWeb of Science
  50. 50.↵
    1. Teal CR,
    2. Haidet P,
    3. Balasubramanyam AS,
    4. Rodriguez E,
    5. Naik AD
    . Measuring the quality of Patients' goals and action plans: development and validation of a novel tool. BMC Med Inform Decis Mak 2012;12:152.
    OpenUrl
  51. 51.↵
    1. DeWalt DA,
    2. Broucksou KA,
    3. Hawk V,
    4. et al
    . Developing and testing the health literacy universal precautions toolkit. Nurs Outlook 2011;59:85–94.
    OpenUrlCrossRefPubMedWeb of Science
  52. 52.↵
    National Academies. Integrating Social Needs Care into the Delivery of Health Care to Improve the Nation's Health. Available from: https://www.nationalacademies.org/our-work/integrating-social-needs-care-into-the-delivery-of-health-care-to-improve-the-nations-health. Accessed April 16, 2020.
Back to top

In this issue

Print
Download PDF
Article Alerts
Email Article
Citation Tools

Jump to section

Keywords