Glucose Control, Self-Care Behaviors and the Presence of the Chronic Care Model in Primary Care Clinics

Abstract

Objective: To examine the relationship between A1c and the extent to which care delivered to patients with type 2 diabetes in primary care clinics is consistent with the Chronic Care Model (CCM), after controlling for self-care behaviors.

Research Design and Methods: A cross-sectional, observational study of care provided to 618 patients with type 2 diabetes across 20 small, autonomous primary care clinics in South Texas. Subjects completed an exit survey. The medical record was abstracted for A1c values. Clinicians completed the Assessment of Chronic Illness Care (ACIC) survey, a validated measure of the extent to which care delivered is consistent with the CCM.

Results: There was a significant relationship between ACIC score and A1c but this relationship varied according to self-care behavior for exercise and was strongest for those who were not adherent to exercise: for every 1 point increase in ACIC, A1c was 0.144% lower. (p<0.001) The relationship between ACIC and A1c for those who are adherent to diet was similar to those who are not, after adjusting for exercise, but the overall level of control was better for those who were adherent to diet.

Conclusions: Characteristics of the primary care clinic where one receives care are an important predictor of glucose control. If resources for implementing the CCM are limited, one might want to focus on clinics with low ACIC scores that serve a population of patients who are sedentary as they may be likely to realize the most benefit in improving glucose control.