Abstract Body: Introduction: Cardiovascular disease (CVD) mortality is higher in people with diabetes mellitus due to the increased prevalence of CVD risk factors. The Office-Gap IMPACT Program (Office-Guidelines Applied to Practice Improving Diabetic Patients’ Adherence to Treatment and Prevention of Cardiovascular Disease) is a patient activation cluster-randomized trial (intervention: Office-GAP + text vs. control: text alone) seeking to improve communication and patient-provider partnerships through patient and provider training in shared decision-making (SDM), use of a guideline-based checklist, and text messaging to improve medication adherence in Federally Qualified Health Care Centers.
Hypothesis: We assessed the hypothesis that individual level demographic and clinical characteristics of patients enrolled in Office-GAP IMPACT would be associated with patient-reported SDM using the CollaboRATE 3-item instrument, which measures three core SDM domains: (1) explanation of health issues, (2) elicitation of patient preferences and (3) integration of patient preferences into decisions with a 10-point response scale for each domain ranging from 0 “No effort was made” to 9 “Every effort was made.”
Methods: The CollaboRATE was completed three months after baseline. A top-scoring method (a rating of 9 for all three items) was used to dichotomize CollaboRATE responses into two categories - participants who reported the highest levels of SDM on each of the three items versus those who did not. Accounting for the cluster-randomized design, generalized estimating equations (GEEs) were used to compare demographics and baseline factors that may be associated with the outcome.
Results: A total of 288 patients were enrolled (intervention, N=158 and control, N=130). Among those with non-missing CollaboRATE scores, 152 (73% ± 3%) had high SDM. The inverse probability of non-missing weighting method was used to account for the missing data in CollaboRATE. Results from the weighted univariable models suggested older patients, history of smoking, and those with BP under control (< 140/90 mmHg) at baseline were more likely to be satisfied with the SDM process. In multivariable logistic regressions, only BP control was statistically significant after adjusting for other factors.
Conclusions: In conclusion, participants with BP control had higher SDM scores, which could lead to better health outcomes. Providers should include the practice of SDM principles in every clinical encounter.