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RX for Managing Diabetes: Trust and Communication

Posted By Prucia Buscell, Thursday, November 01, 2012

Diabetes cost the nation about $100 billion a year, and researchers say some of the most powerful preventive measures are behavior changes among care providers as well as life style changes among people who have the illness and are at risk to get it.

Monica Peek, MD, is a Robert Wood Johnson Foundation Harold Amos Medical Faculty Development Program scholar who studies how the social determinants of health impact African Americans. In an October 2012 presentation at the American Public Health Association, and a recent article described on the RWJF website, Dr. Peek reports: "We found that race, as a social construct, has the potential to influence two key domains of patient trust-interpersonal relationships and medical skills and technical competence. For example, African Americans in our study were concerned that physicians might be biased or using them in medical experiments without their consent. This influenced their perceptions about physicians’ overall competence, bedside manner, and ability to provide them with high-quality care.”

Research has shown that when diabetics engage in shared decision making with their care providers, their compliance with medication regimens, healthy life style choices, and management of blood pressure and blood glucose improve. In their paper "Patient Trust in Physicians and Shared Decision Making Among African Americans with Diabetes," Dr. Peek and colleagues say methods of building trust include enhanced patient education, physician training in interpersonal skills and cultural competence and efforts to engage patients in decision about their care. Although her research focused on African Americans, Dr. Peek believes the findings are applicable to other ethnic and cultural groups struggling with diabetes.

Dr. Peek is also an assistant professor of medicine at University of Chicago Medicine and co-principal investigator of an innovative project called Improving Diabetes Care and Outcomes on the South Side of Chicago, where high rates of diabetes impact a large African American population. The project involves collaboration among six clinics, academic institutions, and community organizations and businesses to provide education and increase access to care. In one program, a nutritionist toured grocery stores with diabetes patients, illustrating healthy food choices, and showing how label information can help manage carbohydrate and sugar intake. In a Food RX initiative, patients who visit one of the clinics can get a coupon for $5 off a $20 order of healthy food at participating Walgreen stores, and a $3 voucher for a weekly farmers market. Dr. Peek says the initiatives put the power of a doctor’s prescription behind nutritional advice. Because many shoppers were buying food at Save-A-Lot stores, initiative leaders established a relationship with the chain, which is now opening more stores in "underserved” neighborhoods that have been described as a "food deserts” and is offering educational information to customers. The store also sponsored a diabetes awareness cooking contest for healthy recipes.

The Improving Diabetes Care and Outcomes project is funded by the Merck Company Foundation through its Alliance to Reduce Disparities in Diabetes across five U.S. cities, and the National Institutes of Health, with the University of Chicago’s Institute for Translational Medicine.

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