How perceived quality of GP care and disease knowledge in diabetes patients correlate with disease outcome.

Background: In addition to good management by the doctor, for type 2 diabetes mellitus (DM2), good self-management is crucial for preventing debilitating and costly long term complications. However, it is not yet clear what influences disease self management. It is known that knowledge of the disease plays a role: more knowledge of the disease is related to better selfmanagement, which is related to better health-outcomes. Better communication with the doctor in turn leads to more knowledge of the disease. One of the underlying mechanisms may be perceived quality of care. It is not known whether high perceived quality of care leads to better disease management and to better disease outcome This study examined whether positive care experiences with the general practitioner (GP) and /or knowledge of the disease are correlated with better disease outcome. Methods: The Consumer Quality Index (CQI) Diabetes questionnaire, measuring patient experiences and knowledge of the disease, was sent to 3,384 DM2 patients in 21 GP practices in order to assess perceived quality of care and knowledge of the disease. In addition, medical data were retrieved from GP’s medical records to assess disease outcomes. Experiences from the CQI on diabetes-specific communication were compared to disease outcomes and knowledge using regression analyses. Results: Patients with positive care experiences had better disease outcomes for a number of DM2-related measures, e.g.better creatinine levels, less hypertension, less manifest cardiovascular, cerebral and renal complications, and they exercised more. They were also better informed about the disease. Patients with more knowledge of the disease also showed better outcomes. Conclusions: High perceived quality of GP care and knowledge of the disease are both related to better disease-specific outcomes. High perceived quality of care is also related to a better understanding of the disease. Therefore, it is crucial for the GP to ensure the patient has knowledge of the disease, and also to invest in increasing the quality of care as perceived by the patient. Both will lead to better disease outcome. (aut. ref.)