Skip to main content
SpringerLink
Log in

Relationship of patient request fulfillment to compliance, glycemic control, and other health care outcomes in insulin-dependent diabetes

  • Original Articles
  • Published:
Journal of General Internal Medicine Aims and scope Submit manuscript

Abstract

Patients’ perceptions of the extent to which their health care needs have been met may affect compliance with prescribed health behaviors and related health outcomes. The authors examined the relationships of “patient request fulfillment” to patient compliance, glycemic control, and several other health care outcomes in 51 adult outpatients with insulin-dependent diabetes mellitus. On average, patients retrospectively cited 4.5 long-term requests, of which over three-fourths were fulfilled. Fulfillment of these requests was significantly associated with patient satisfaction, perceived health status, fewer insulin reactions, and greater insulin injection time reliability (p<0.05), but not with several other measures of compliance. Higher patient request fulfillment at single visits was correlated, as hypothesized, with subsequent reduction in glycosylated hemoglobin, but this association was not statistically significant. These results suggest that patient request fulfillment is associated with several aspects of health behavior and health status in adults with insulin-dependent diabetes. Further studies are needed to confirm these observations and determine whether strategies to enhance patient request fulfillment can enhance health care outcomes.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Lazare A, Eisenthal S, Wasserman L. The customer approach to patienthood: attending to patient requests in walk-in clinic. Arch Gen Psychiat 1975;32:553–8.

    PubMed  CAS  Google Scholar 

  2. Speedling EJ, Rose DN. Building an effective doctor—patient relationship: from patient satisfaction to patient participation. Soc Sci Med 1985;21:115–20.

    Article  PubMed  CAS  Google Scholar 

  3. Levenstein JH, McCracken EC, McWhinney IR, Stewart MA, Brown JB. The patient-centred clinical method. 1. A model for the doctor—patient interaction in family medicine. Fam Pract 1986;3:24–30.

    Article  PubMed  CAS  Google Scholar 

  4. Lazare A, Eisenthal S. A negotiated approach to the clinical encounter. 1. Attending to the patient’s perspective. In: Lazare A, ed. Outpatient psychiatry. Baltimore: Williams and Wilkins, 1979;144–56.

    Google Scholar 

  5. Starfield B, Steinwachs D, Morris I, et al. Patient—doctor agreement about problems needing follow-up visit. JAMA 1979;242:344–6.

    Article  PubMed  CAS  Google Scholar 

  6. Greenfield S, Kaplan S, Ware JE. Expanding patient involvement in care: effects on patient outcome. Ann Intern Med 1985;102:520–8.

    PubMed  CAS  Google Scholar 

  7. Uhlmann RF, Carter WB, Inui TS. Fulfillment of patient requests in a general medicine clinic. Am J Public Health 1984;74:257–8.

    Article  PubMed  CAS  Google Scholar 

  8. Glasgow RE, McCaul KD, Schafer LC. Self-care behaviors and glycemic control in type I diabetes. J Chronic Dis 1987;40:399–412.

    Article  PubMed  CAS  Google Scholar 

  9. Isaac S, Michael WB. Handbook in research and evaluation for education and the behavioral sciences. San Diego: EdITS, 1981;121–2.

    Google Scholar 

  10. Turkat ID. Diabetics’ self-report of medical utilization: a test of validity. Psychol Rep 1982;50:1160–2.

    PubMed  CAS  Google Scholar 

  11. Linn MW, Linn BS, Harris R. The importance of self-assessed health in patients with diabetes. Diabetes Care 1980;3:599–606.

    Article  PubMed  CAS  Google Scholar 

  12. Inui TS, Jared RA, Carter WB, et al. Effects of a self-administered health history on new-patient visits in a general medicine clinic. Med Care 1979;17:1221–8.

    Article  PubMed  CAS  Google Scholar 

  13. Ware J, Snyder M. Dimensions of patient attitudes regarding doctors and medical care services. Med Care 1975;13:699–82.

    Article  Google Scholar 

  14. Sackett DL. A compliance practicum for the busy practitioner. In: Haynes RB, Taylor DW, Sackett DL, eds. Compliance in health care. Baltimore: Johns Hopkins University Press, 1979;286–94.

    Google Scholar 

  15. Koenig RJ, Peterson CM, Jones RL, et al. The correlation of glucose regulation and hemoglobin A1 in diabetes mellitus. N Engl J Med 1976;295:417–20.

    Article  PubMed  CAS  Google Scholar 

  16. Fluckiger R, Winterhalter KH. In vitro synthesis of hemoglobin A1C. FEBS Lett 1976;71:356–60.

    Article  PubMed  CAS  Google Scholar 

  17. Parker KM, England JD, Da Costa J, et al. Improved colorimetric assay for glycosylated hemoglobin. Clin Chem 1981;27:669–72.

    PubMed  CAS  Google Scholar 

  18. Pecoraro RE, Graf RJ, Halter JB, et al. Comparison of a colorimetric assay for glycosylated hemoglobin with ion-exchange chromatography. Diabetes 1979;28:1120–5.

    Article  PubMed  CAS  Google Scholar 

  19. Pecoraro RE, Koepsell TD, Chen MS, et al. Comparative clinical reliability of fasting plasma glucose and glycosylated hemoglobin in noninsulin-dependent diabetes mellitus. Diabetes Care 1986;9:370–5.

    Article  PubMed  CAS  Google Scholar 

  20. Uhlmann RF, Inui TS, Carter WB. Patient requests and expectations: definitions and clinical applications. Med Care 1984;22:681–5.

    Article  PubMed  CAS  Google Scholar 

  21. Good MD, Good BJ. Patient requests in primary care clinics. In: Chrisman NJ, Maretzki TW, eds. Clinically applied anthropology. Boston: D. Reidel, 1982;275–95.

    Google Scholar 

  22. Cohen J. A coefficient of agreement for nominal scales. Educ Psychol Measurement 1960;20:37–461.

    Article  Google Scholar 

  23. Nie NH, Hull CH, Jenkins JG, et al. Statistical package for the social sciences. 2nd ed. New York: McGraw-Hill, 1975.

    Google Scholar 

  24. Cronbach LJ, Furby L: How we should measure “change”—or should we? Psychol Bull 1970;74:68–80.

    Article  Google Scholar 

  25. Korsch BM, Gozzi EK, Francis V: Gaps in doctor—patient communication: 1. Doctor—patient interaction and patient satisfaction. Pediatrics 1968;42:855–71.

    PubMed  CAS  Google Scholar 

  26. Eisenthal S, Emery R, Lazare A, et al. “Adherence” and the negotiated approach to patienthood. Arch Gen Psychiat 1979;36:393–8.

    PubMed  CAS  Google Scholar 

  27. Sackett DL, Haynes RB, Tugwell P. Clinical epidemiology: a basic science for clinical medicine. Boston: Little, Brown, 1985;230–4.

    Google Scholar 

  28. Vinicor F, Cohen SJ, Mazzuca SA, et al. Diabeds: a randomized trial of the effects of physician and/or patient education on diabetes patient outcomes. J Chronic Dis 1987;40:345–56.

    Article  PubMed  CAS  Google Scholar 

  29. Greenfield S, Ware JE, Martin RA, Frank HJL. Expanded patient involvement in medical care: effects on blood sugar. Clin Res 1986;34:819A.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Gerontology and Geriatric Medicine, Department of Medicine, Harborview Medical Center, University of Washington, Seattle, Washington

    Richard F. Uhlmann MD, MPH

  2. Division of General Internal Medicine and Robert Wood Johnson Clinical Scholars Program, Department of Medicine, University of Washington, USA

    Thomas S. Inui ScM, MD

  3. Division of General Internal Medicine, Department of Medicine, Seattle Veterans Administration Medical Center, University of Washington, USA

    Roger E. Pecoraro MD

  4. Northwest Health Services Research and Development Field Program, Seattle Veterans Administration Medical Center, USA

    William B. Carter PhD

  5. Department of Health Services, University of Washington, USA

    William B. Carter PhD

Authors
  1. Richard F. Uhlmann MD, MPH
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Thomas S. Inui ScM, MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Roger E. Pecoraro MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. William B. Carter PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Additional information

Supported in part by the Northwest Health Services Research and Development Field Program, Seattle Veterans Administration Medical Center. Dr. Uhlmann was a Veterans Administration Fellow in the Robert Wood Johnson Clinical Scholars Program while working on this project and is the recipient of National Institute on Aging Academic Award K08 AG00265. The opinions expressed herein are those of the authors and not necessarily those of the Veterans Administration or the Robert Wood Johnson Foundation.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Uhlmann, R.F., Inui, T.S., Pecoraro, R.E. et al. Relationship of patient request fulfillment to compliance, glycemic control, and other health care outcomes in insulin-dependent diabetes. J Gen Intern Med 3, 458–463 (1988). https://doi.org/10.1007/BF02595922

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF02595922

Key words

Search

Navigation