Dataset Information

Hypoglycemia Communication in Primary Care Visits for Patients with Diabetes.

ABSTRACT:

Background

Hypoglycemia is a common and serious adverse effect of diabetes treatment, especially for patients using insulin or insulin secretagogues. Guidelines recommend that these patients be assessed for interval hypoglycemic events at each clinical encounter and be provided anticipatory guidance for hypoglycemia prevention.

Objective

To determine the frequency and content of hypoglycemia communication in primary care visits.

Design

Qualitative study PARTICIPANTS: We examined 83 primary care visits from one urban health practice representing 8 clinicians and 33 patients using insulin or insulin secretagogues.

Approach

Using a directed content analysis approach, we analyzed audio-recorded primary care visits collected as part of the Achieving Blood Pressure Control Together study, a randomized trial of behavioral interventions for hypertension. The coding framework included communication about interval hypoglycemia, defined as discussion of hypoglycemic events or symptoms; the components of hypoglycemia anticipatory guidance in diabetes guidelines; and hypoglycemia unawareness. Hypoglycemia documentation in visit notes was compared to visit transcripts.

Key results

Communication about interval hypoglycemia occurred in 24% of visits, and hypoglycemic events were reported in 16%. Despite patients voicing fear of hypoglycemia, clinicians rarely assessed hypoglycemia frequency, severity, or its impact on quality of life. Hypoglycemia anticipatory guidance was provided in 21% of visits which focused on diet and behavior change; clinicians rarely counseled on hypoglycemia treatment or avoidance of driving. Limited discussions of hypoglycemia unawareness occurred in 8% of visits. Documentation in visit notes had low sensitivity but high specificity for ascertaining interval hypoglycemia communication or hypoglycemic events, compared to visit transcripts.

Conclusions

In this high hypoglycemia risk population, communication about interval hypoglycemia and counseling for hypoglycemia prevention occurred in a minority of visits. There is a need to support clinicians to more regularly assess their patients' hypoglycemia burden and enhance counseling practices in order to optimize hypoglycemia prevention in primary care.

SUBMITTER: Pilla SJ

PROVIDER: S-EPMC8175615 | biostudies-literature | 2021 Jun

REPOSITORIES: biostudies-literature

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Publications

Hypoglycemia Communication in Primary Care Visits for Patients with Diabetes.

Pilla Scott J SJ Park Jenny J Schwartz Jessica L JL Albert Michael C MC Ephraim Patti L PL Boulware L Ebony LE Mathioudakis Nestoras N NN Maruthur Nisa M NM Beach Mary Catherine MC Greer Raquel C RC

Journal of general internal medicine 20210121 6

<h4>Background</h4>Hypoglycemia is a common and serious adverse effect of diabetes treatment, especially for patients using insulin or insulin secretagogues. Guidelines recommend that these patients be assessed for interval hypoglycemic events at each clinical encounter and be provided anticipatory guidance for hypoglycemia prevention.<h4>Objective</h4>To determine the frequency and content of hypoglycemia communication in primary care visits.<h4>Design</h4>Qualitative study PARTICIPANTS: We exa ...[more]

PMID: 33479925

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Dataset Information

Hypoglycemia Communication in Primary Care Visits for Patients with Diabetes.

Background

Objective

Design

Approach

Key results

Conclusions

Publications

Hypoglycemia Communication in Primary Care Visits for Patients with Diabetes.

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