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To determine the extent to which chronic illness and disease severity affect patient satisfaction with their primary care provider in general internal medicine clinics.Cross-sectional mailed questionnaire study.Primary care clinics at 7 Veterans Affairs medical centers.Of 62,487 patients participating in the Ambulatory Care Quality Improvement Project, 35,383 (57%) returned an initial screening questionnaire and were subsequently sent a satisfaction questionnaire. Patients (N=21,689; 61%) who returned the Seattle Outpatient Satisfaction Survey (SOSQ) were included in the final analysis, representing 34% of the original sample.The organizational score of the SOSQ measures satisfaction with health care services in the internal medicine clinic, and the humanistic scale measures patient satisfaction with the communication skills and humanistic qualities of the primary care physician. For ischemic heart disease (IHD), chronic obstructive pulmonary disease (COPD), and diabetes, patient ability to cope with their disease was more strongly associated with patient satisfaction than disease severity. Among IHD patients, improvement in ability to cope emotionally with their angina was associated with higher SOSQ organizational scores (standardized beta=0.18; P.001) but self-reported physical limitation due to angina was not (beta=0.01; P=.65). Similarly, in COPD, improved ability to cope with dyspnea was associated with greater organizational scores (beta=0.11; P.001) but physical function was not (beta=-0.03; P=.27). For diabetes, increased education was associated with improved organizational scores (beta=0.31; P.001) but improvement in symptom burden was not (beta=0.03; P=.14). Similar results were seen with prediction of SOSQ humanistic scores.Patient education and ability to cope with chronic conditions are more strongly associated with satisfaction with their primary care provider than disease severity. Further improvements in patient education and self-management may lead to improved satisfaction and quality of care.

Studies, mostly from outside the United States, have found high prevalence of diabetes, coronary heart disease (CHD), and hypertension among Asian Indians, despite low rates of associated risk factors.To analyze the prevalence of obesity, diabetes, CHD, hypertension, and other associated risk factors among Asian Indians in the United States compared to non-Hispanic whites.Cross-sectional study using data from the National Health Interview Survey (NHIS) for 1997, 1998, 1999, and 2000. We analyzed 87,846 non-Hispanic whites and 555 Asian Indians.Whether a subject reported having diabetes, CHD, or hypertension.Asian Indians had lower average body mass indices (BMIs) than non-Hispanic whites and lower rates of tobacco use, but were less physically active. In multivariate analysis controlling for age and BMI, Asian Indians had significantly higher odds of borderline or overt diabetes (adjusted OR [AOR], 2.70; 95% confidence interval [CI], 1.72 to 4.23). Multivariate analysis also showed that Asian Indians had nonsignificantly lower odds ratios for CHD (AOR, 0.58; 95% CI, 0.25 to 1.35) and significantly lower odds of reporting hypertension (AOR, 0.58; 95% CI, 0.42 to 0.82) compared to non-Hispanic whites.Asian Indians in the United States have higher odds of being diabetic despite lower rates of obesity. Unlike studies on Asian Indians in India and the United Kingdom, we found no evidence of an elevated risk of CHD or hypertension. We need more reliable national data on Asian Indians to understand their particular health behaviors and cardiovascular risks. Research and preventive efforts should focus on reducing diabetes among Asian Indians.

Management of diabetes, and in particular blood glucose, can be complex and burdensome.To evaluate patient views of the burdens of therapy and its impact on self-management.Veteran patients with type 2 diabetes.Mailed survey.Patients described their views of the burden of diabetes treatments, adherence, and clinical and demographic status. Factors associated with ratings of burden and adherence to therapy were examined using multivariate regression methods.The response rate was 67% (n=1,653). Patients viewed pills as the least burdensome treatment and insulin as the most burdensome. Ratings of the burden of insulin were lower if a patient had prior experience with therapy. Adherence to prescribed therapy varied substantially; for example, patients followed medication recommendations more closely than other areas of self-management. Multivariate analyses showed that the main predictor of adherence was patients' ratings of the burden of therapy.Injected insulin regimens are viewed as highly burdensome by patients, although this burden is attenuated by experience. Adherence to self-management is strongly and independently correlated with views of treatment burden. The burden of diabetes-related treatments may be a source of suboptimal glucose control seen in many care settings. Providers should consider the burden of treatment for a particular patient and its impact on adherence as part of a decision-making process to design effective treatment regimens.

To examine circumstances surrounding suboptimally timed retinal photocoagulation, we reviewed the medical records of 238 patients who had received photocoagulation for diabetic retinopathy at one of three large referral centers. Forty-three percent (95% confidence interval, 36% to 49%) of cases were rated as probably or definitely suboptimally timed (i.e., patient could have benefited from earlier photocoagulation). About one third of cases were due to patients going many years without screening (> 3 years), and two thirds were associated with surveillance problems (failures to achieve close follow-up for known retinopathy). We found that suboptimal timing of photocoagulation was common but was not due to patients going between 13 and 36 months between screening visits, suggesting that current performance measures, which focus on annual retinal examinations, may be requiring wasteful care while not addressing a major quality problem.

BACKGROUND: The Internet represents a promising tool to improve diabetes care. OBJECTIVE: To assess differences in demographics, self-care behaviors, and diabetes-related risk factor control by frequency of Internet use. DESIGN AND PARTICIPANTS: We surveyed 909 patients with type 2 diabetes attending primary care clinics. MEASUREMENTS: Frequency of Internet use, socioeconomic status, and responses to the Problem Areas in Diabetes (PAID), Summary of Diabetes Self-care Activities (SDSCA), and Health Utilities Index (HUI) scales. Survey responses were linked to last measured hemoglobin Alc, cholesterol, and blood pressure results. Comorbidities and current medications were obtained from the medical record. RESULTS: Internet “never-users” (n=588, 66%) were significantly older (70.0±11.2 vs 59.0±11.3 years; P high school; P

Maintaining optimal glycemic control is an important goal of therapy in patients with diabetes mellitus. Patients of Hispanic ancestry have been shown to have high rates of diabetes and poor glycemic control (PGC). Although depression is common in adults with diabetes, its relationship to glycemic control remains unclear, especially among Hispanics.To assess the association of depression with PGC in Hispanics.Data from a cross-sectional mental health survey in primary care were crosslinked to the hospital's computerized laboratory database.Urban general medicine practice at a teaching hospital.Two hundred and nine patients (mean [standard deviation] age, 57.1 [10.3] years; 68% females) with recent International Classification of Diseases, Ninth Revision (ICD-9) codes for diabetes mellitus, and 1 or more hemoglobin A(1c) (HbA(1c)) tests.Probability of PGC (HbA(1c)or=8%).Probability for PGC steadily increased with severity of depression. Thirty-nine (55.7%) of the 70 patients with major depression had HbA(1c)or=8%, compared with 39/92 (42.4%) in the minimal to mild depression group, and 15/47 (31.9%) in the no depression group (P(trend)=.01; adjusted odds ratio, 3.27; 95% confidence interval, 1.23 to 8.64, for moderate or severe depression vs no depression). Only 29 (41.4%) of the patients with major depression received mental health treatment in the previous year.In this primary care sample of Hispanic patients with diabetes, we found a significant association between increasing depression severity and PGC. Yet, less than one half of the patients with moderate or severe depression received mental health treatment in the previous year. Improving identification and treatment of depression in this high-risk population might have favorable effects on diabetic outcomes.