Factors influencing diabetes treatment satisfaction in the INtegrating DEPrEssioN and Diabetes treatmENT randomized clinical trial: A multilevel model analysis.

Deepa Rao, Madhu Kosari, Bhavani Sundari, Zach Cooper, Viswanathan Mohan, Mohammed K Ali, K M Venkat Narayan, Lydia Chwastiak, Subramani Poongothai, Shivani A Patel, R Khadgawat, Radha Shankar, R M Anjana, Leslie Johnson, N Tandon, R Sagar, B Sosale, S R Aravind, G R Sridhar

Journal: Diabetic medicine : a journal of the British Diabetic Association 2024;41(12):e15412

PMID: 39039715

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Abstract

AIMS

Patient satisfaction is associated with positive diabetes outcomes. However, there are no identified studies that evaluate both patient- and clinic-level predictors influencing diabetes care satisfaction longitudinally.

METHODS

Data from the INtegrating DEPrEssioN and Diabetes treatmENT trial was used to perform the analysis. We used fixed and random effects models to assess whether and how changes in patient-level predictors (treatment assignment, depression symptom severity, systolic blood pressure, body mass index, LDL cholesterol, and haemoglobin A1C) from 0 to 24 months and clinic-level predictors (visit frequency, visit cost, number of specialists, wait time, time spent with healthcare provider, and receiving verbal reminders) measured at 24 months influence diabetes care satisfaction from 0 to 24 months.

RESULTS

Model 1 (patient-level predictors) accounted for 7% of the change in diabetes satisfaction and there was a significant negative relationship between change in depressive symptoms and care satisfaction (β = -0.23, SE = 0.12, p < 0.05). Within Model 1, 2% of the variance was explained by clinic-level predictors. Model 2 included both patient- and clinic-level predictors and accounted for 18% of the change in diabetes care satisfaction. Within Model 2, 9% of the variance was attributed to clinic-level predictors. There was also a cross-level interaction where the change in depression had less of an impact on the change in satisfaction for those who received a verbal reminder (β = -0.11, SE = 0.21, p = 0.34) compared with those who did not receive a reminder (β = -0.62, SE = 0.08, p < 0.01).

CONCLUSIONS

Increased burden of depressive symptoms influences diabetes care satisfaction. Clinic-level predictors also significantly influence diabetes care satisfaction and can reduce dissatisfaction in primary care, specifically, reminder calls from clinic staff.

Address: University of Georgia School of Social Work, Athens, Georgia, USA.; Department of Family and Preventive Medicine, School of Medicine, Emory University, Atlanta, Georgia, USA.; Department of Family and Preventive Medicine, School of Medicine, Emory University, Atlanta, Georgia, USA.; Emory Global Diabetes Research Center, Woodruff Health Sciences Center and Emory University, Atlanta, Georgia, USA.; Emory Global Diabetes Research Center, Woodruff Health Sciences Center and Emory University, Atlanta, Georgia, USA.; Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialties Centre, Chennai, Tamil Nadu, India.; Department of Endocrinology, All India Institute of Medical Sciences, New Delhi, India.; Endocrine and Diabetes Centre, Visakhapatnam, India.; Diacon Hospital, Bangalore, India.; Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India.; Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA.; Department of Global Health, University of Washington School of Public Health, Seattle, WA, USA.

DOI: 10.1111/dme.15412

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MeSH Terms: Humans, Female, Male, Patient Satisfaction, Middle Aged, Depression, Diabetes Mellitus, Type 2, Glycated Hemoglobin, Adult, Multilevel Analysis, Aged