Change in metabolic control and functional status after hospitalization. Impact of patient activation intervention in diabetic patients.

Abstract

OBJECTIVE: To determine whether a short intervention to enhance patient information seeking and decision making during hospitalization results in improved metabolic control and functional status in patients with diabetes mellitus. RESEARCH DESIGN AND METHODS: A randomized clinical trial was conducted in which control patients received a comprehensive 3-day evaluation and educational program, whereas experimental patients received a 45-min patient activation intervention and a 1-h self-administered booster in addition to the program. Metabolic control and functional status were measured at baseline and 4 mo postdischarge. RESULTS: During their discharge discussions, experimental patients asked significantly more questions than control patients (7.4 vs. 3.0, P less than .001) and 4 mo later reported significantly fewer physical limitations in activities of daily living than the control group (P = 0.02). Improvement in metabolic control was statistically significant only for experimental patients (P = 0.02), although their glycosylated hemoglobin levels were not significantly lower than control patients' at follow-up. The intervention did not diminish physician satisfaction with patient interactions, although it may have increased physician frustration with responsibilities that competed with patient care. CONCLUSIONS: These results suggest that the addition of a patient activation intervention to a comprehensive diabetes management program may substantially enhance physical functioning among adults with diabetes mellitus.