Primary Care Research

Patients with diabetes have better glucose control when they receive care at primary care clinics that adhere to the chronic care model

People with type 2 diabetes need to control their blood glucose levels (measured by hemoglobin A1C) in order to avoid increased risk of complications from diabetes. However, there has been no significant improvement of these levels among people suffering from type 2 diabetes in the United States over the last decade. A new study found a relationship between A1C control and the degree to which primary care clinics adhered to the chronic care model (CCM), which is an organizational approach to improving chronic illness care.

Researchers conducted an observational study of 20 primary care clinics with 45 primary care physicians and 617 patients. The extent to which the clinics delivered care that was consistent with the CCM was measured by the Assessment of Chronic Illness Care (ACIC) survey. The study revealed a significant relationship between the ACIC score and A1C levels, but self-care behaviors, such as exercise, caused some variance.

The strongest relationship appeared in those who did not adhere to exercise recommendations; for every increase in the ACIC score there was a decrease in A1C. Causation could not be determined in either direction. No significant relationship was discovered between ACIC score and age, race, sex, diet, or medication adherence.

Since the relationship between ACIC score and A1C was most significant for those not adhering to exercise guidelines, the authors recommend focusing resources for implementing the CCM on clinics with low ACIC scores that serve a population of sedentary patients, because they may benefit the most from improving glucose control. This study was supported in part by the Agency for Healthcare Research and Quality (HS13008).

More details are in "Glucose control, self-care behaviors, and the presence of the chronic care model in primary care clinics," by Michael L. Parchman, M.D., M.P.H., Jacqueline A. Pugh, M.D., Chen-Pin Wang, Ph.D., Raquel L. Romero, M.D., M.P.H., in the November 2007 Diabetes Care 30(11), pp. 2849-2854.

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