Seize Technology to Strengthen Doctor-Patient Interaction

Allison Shelley

June 27, 2016




Most people with type 2 diabetes are managed in primary care, but many of these patients have multiple health problems that are challenging for both patients and physicians to address in a single visit.


The solution might  lie in marrying old-fashioned clinical practice with cutting-edge technologies, researchers told delegates at the American Diabetes Association (ADA) 76th Scientific Sessions in New Orleans.


Primary care providers are challenged by unprepared patients and insufficient time, senior investigator Richard Grant, MD, told Medscape Medical News after his presentation.

            Our work has been dubbed 'the hand on the doorknob' study.            

"Our work has been dubbed 'the hand on the doorknob' study," he quipped. "Important concerns are often raised at the end of the appointment, when the physician is leaving the room. We want to help doctors and patients prioritize issues so that doesn't happen."


Dr Grant and his colleagues from Kaiser Permanente in Oakland, California, developed a secure messaging portal linked to patient health records. Patients were asked to list their top one or two health concerns when they made an appointment. This information was then available to physicians when they opened patient charts.


The last thing the investigators wanted to do was contribute to information overload or inefficiency requiring late-night emails. "We were very careful to integrate our approach into the workflow so that the note was where the physician needed it at the time it would help," Dr Grant explained.


The study, funded by the National Institutes of Health, is ongoing and involves 30 primary care practices in an integrated care system. A baseline survey was completed by 141 of 146 primary care providers — a 97% response rate — and identified barriers to the care of patients with uncontrolled type 2 diabetes.


Eligible patients had type 2 diabetes and an HbA1c level above 8.0% when last measured. Interestingly, less than half of the physician visits included diabetes as a top concern. For visits related to nondiabetes-specific problems, patients prioritized important life changes and mood or motivation issues.


"There are many challenges in treating patients with inadequately controlled diabetes," Dr Grant acknowledged. "Some of these issues are medical, but some are behavioral or social and will require the help of a team, as the ADA recommends."


The approach taken by Dr Grant and his colleagues is to educate the patient to become a more effective member of that team. "Improving glycemic control in primary care may require that patients' nondiabetes-related priorities are also identified and addressed," he pointed out.


This study was funded by the National Institute of Diabetes and Digestive and Kidney Diseases. Dr Grant has disclosed no relevant financial relationships.


American Diabetes Association (ADA) 76th Scientific Sessions: Poster 1210. Presented June 12, 2016.


Follow Allison Shelley on Twitter: @allishelley



Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.
Post as: