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Glucose Control, Self-Care Behaviors, and the Presence of the Chronic Care Model in Primary Care Clinics

¹ Department of Family & Community Medicine/University of Texas Health Science Center–San Antonio, San Antonio, Texas
² VERDICT Health Services Research Center/South Texas Veterans Health Care System, San Antonio, Texas
³ Department of Medicine/University of Texas Health Science Center–San Antonio, San Antonio, Texas

Address correspondence and reprint requests to Michael L. Parchman, MD, MPH, South Texas Veterans Health Care System #11C6, 7400 Merton Minter Blvd., San Antonio, TX 78229-4404. E-mail: parchman{at}uthscsa.edu

OBJECTIVE—The purpose of this study was to examine the relationship between A1C and the extent to which care delivered to patients with type 2 diabetes in primary care clinics is consistent with the chronic care model (CCM), after controlling for self-care behaviors.

RESEARCH DESIGN AND METHODS—This was a cross-sectional, observational study of care provided to 618 patients with type 2 diabetes across 20 small, autonomous primary care clinics in South Texas. Subjects completed an exit survey. The medical record was abstracted for A1C values. Clinicians completed the Assessment of Chronic Illness Care (ACIC) survey, a validated measure of the extent to which care delivered is consistent with the CCM.

RESULTS—There was a significant relationship between ACIC score and A1C, but this relationship varied according to self-care behavior for exercise and was strongest for those who did not adhere to exercise recommendations: for every 1-point increase in ACIC score, A1C was 0.144% lower (P < 0.001). The relationship between ACIC score and A1C for those who adhered to their diet was similar to that for those who did not, after adjusting for exercise, but the overall level of control was better for those who adhered to their diet.

CONCLUSIONS—Characteristics of the primary care clinic where one receives care are an important predictor of glucose control. If resources for implementing the CCM are limited, one might want to focus on clinics with low ACIC scores that serve a population of patients who are sedentary because this population may be likely to realize the most benefit from improved glucose control.

Abbreviations: ACIC, Assessment of Chronic Illness Care • CCM, chronic care model

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