Primary care physicians often have limited time with patients during their visits, affecting treatment adherence, health outcomes, and patient satisfaction—especially for patients with complex chronic conditions such as diabetes mellitus. (12)(18) Diabetes outcomes are primarily influenced by patients’ ability to self-manage and make appropriate behavior changes. (17) Not receiving enough personalized care can negatively impact patients’ motivation to change. Addressing your patients’ barriers to change and having a supportive patient-practitioner relationship can help improve patient adherence and satisfaction. (10)(13)
The team care model is patient-centered and allows patients to receive primary care from other qualified healthcare providers (e.g., nurse practitioners). Primary care under this model has shown to be a practical way to improve the quality of patient care. (12) Nurse practitioners often spend more time with patients, provide more education, and generally receive better patient satisfaction ratings than physician care alone. (2)
Fullscript offers a variety of other educational resources for both practitioners and their patients, as well as innovative tools that nurse practitioners can use to help promote behavioral change in their patients with chronic conditions. Keep reading below to learn more about diabetes education and supporting behavioral change in patients with diabetes.
Supporting diabetes-related behavioral change
Behavioral change is a complex journey that the patient’s perceived barriers can greatly influence. (17) Individuals with diabetes are twice as likely to experience depression, which can negatively affect their ability to self-manage their condition. (16) Other common barriers to behavior change include:
- Confusing or unclear practitioner communication
- Financial restrictions
- High provider/clinic workload
- Lack of patient motivation, willingness, or trust
- Low levels of health literacy and ineffective patient education
- Poor patient-practitioner relationship (6)(14)
While team-based care addresses specific barriers, there are several other techniques and Fullscript features that nurse practitioners can use to invoke positive health outcomes for patients with diabetes.
Techniques that support behavior change
There are several ways to promote behavior change and a good patient-practitioner relationship, including using inclusive communication, following the patient-centered care model, and helping patients set realistic health goals.
1. Patient-centered care
Patient-centered care is a practice model that emphasizes the needs and preferences of the patient to provide the best possible care. The patient-centered care model is a popular evidence-based approach to healthcare associated with higher patient satisfaction, improved health outcomes, and enhanced communication. (1)(11) Applying the elements of patient-centered care to patients with diabetes can improve diabetes-related self-care and overall quality of life. (20)
2. Motivational interviewing
Motivational interviewing (MI) is a highly effective strategy for encouraging behavior change in patients with diabetes. MI makes patients feel empowered, improving treatment adherence and willingness to change. Various studies have shown that MI improves glycemic control and HbA1c (a measure of blood sugar levels), weight loss, well-being, and quality of life. (5)(7)(9)
3. SMART goals
Assisting patients with setting health goals that are specific, measurable, attainable, realistic, and time-related (SMART) may help increase patient success. (3) Try to focus on the behavior change(s) necessary for reaching their desired health outcomes, and provide tools and education, such as goal-tracking apps or worksheets, to encourage achievement.
Fullscript features that support behavior change
With so many barriers to patient engagement, invoking health behavior change in patients with type 2 diabetes can be complex. Fortunately, there are a variety of Fullscript features that can help improve treatment adherence and motivate patients to adopt and maintain healthy behaviors.
1. Adherence boosting tools
Patient appointments can be infrequent, with little communication between visits. (19) As reported by patients with type 2 diabetes, regular communication between visits may help them better manage their condition. (15) As your adherence partner, Fullscript offers a variety of tools that can help keep your patients engaged, including:
- Adherence surveys
- Automatic ordering (Autoship)
- Insights dashboard
- Patient discounts/promotions
- Refill reminders
2. Patient education (in-app Resource Library)
Diabetes education can improve health literacy, empowering patients to become more engaged in their care and developing their treatment plans. Patients who are more engaged are more likely to experience better health outcomes. (4)(8)
Fullscript has embedded a comprehensive library of evidence-based materials in our treatment plan tool to make educating patients a seamless experience for everyone. Similar to the SMART goal-setting worksheet, the Fullscript Resource Library boasts over 150 patient education resources, including handouts, infographics, and detailed guides. Patient education has many benefits, including reinforcing essential information for condition management, preventing complications, and advocating self-care. (8)
Take the time to review the provided educational materials with your patient during their visit to answer questions and highlight critical information. Then, emphasize the importance of the provided patient education in your follow-up communications and treatment plan.
3. Practitioner education
Treatment adherence and health behavior changes are integral components of patient wellness, but with so many factors influencing both, it can be challenging to know how to approach each patient’s unique needs. Similar to patient education resources, Fullscript’s Integrative Medical Advisory team also produces evidence-based practitioner resources, including clinical guides, protocols, and whitepapers. Whether you’re looking for information on common drug-nutrient interactions, or ways to improve patient treatment adherence, there are many Fullscript resources to choose from.
The bottom line
Consistent adherence to a treatment regimen is essential for managing type 2 diabetes. Nonadherence can result from multiple factors, but one significant influence is patient-doctor communication. Following a team-based care practice model that lets nurse practitioners provide primary care can positively influence the patient-practitioner relationship. Combined with practical behavior change tools and methods of communication, nurse practitioners can help promote positive health outcomes for their patients. Fullscript offers a variety of resources, including patient and practitioner education and an insights dashboard that practitioners can use to help patients meet their health goals.
- Agency for Healthcare Research and Quality. (2018). Six domains of health care quality. https://www.ahrq.gov/talkingquality/measures/six-domains.html
- American Association of Nurse Practitioners. (2020). Quality of nurse practitioner practice. https://www.aanp.org/advocacy/advocacy-resource/position-statements/quality-of-nurse-practitioner-practice
- Bailey, R. R. (2019). Goal setting and action planning for health behavior change. American Journal of Lifestyle Medicine, 13(6), 615–618.
- Centers for Disease Control and Prevention. (2021). Patient engagement. https://www.cdc.gov/healthliteracy/researchevaluate/patient-engage.html
- Channon, S. J., Huws-Thomas, M. V., Rollnick, S., Hood, K., Cannings-John, R. L., Rogers, C., & Gregory, J. W. (2007). A multicenter randomized controlled trial of motivational interviewing in teenagers with diabetes. Diabetes Care, 30(6), 1390–1395.
- Chegini, Z., Janati, A., Babaie, J., & Pouraghaei, M. (2020). Exploring the barriers to patient engagement in the delivery of safe care in Iranian hospitals: A qualitative study. Nursing Open, 7(1), 457–465.
- Dellasega, C., Añel-Tiangco, R. M., & Gabbay, R. A. (2012). How patients with type 2 diabetes mellitus respond to motivational interviewing. Diabetes Research and Clinical Practice, 95(1), 37–41.
- Fereidouni, Z., Sabet Sarvestani, R., Hariri, G., Kuhpaye, S. A., Amirkhani, M., & Kalyani, M. N. (2019). Moving into action: The master key to patient education. The Journal of Nursing Research: JNR, 27(1), 1–8.
- Greaves, C. J., Middlebrooke, A., O’Loughlin, L., Holland, S., Piper, J., Steele, A., Gale, T., … & Daly, M. (2008). Motivational interviewing for modifying diabetes risk: A randomised controlled trial. The British Journal of General Practice: The Journal of the Royal College of General Practitioners, 58(553), 535–540.
- Greene, J., Hibbard, J. H., Alvarez, C., & Overton, V. (2016). Supporting patient behavior change: Approaches used by primary care clinicians whose patients have an increase in activation levels. Annals of Family Medicine, 14(2), 148–154.
- Greene, S. M., Tuzzio, L., & Cherkin, D. (2012). A framework for making patient-centered care front and center. The Permanente Journal, 16(3), 49–53.
- Guo, F., Lin, Y.-L., Raji, M., Leonard, B., Chou, L.-N., & Kuo, Y.-F. (2020). Processes and outcomes of diabetes mellitus care by different types of team primary care models. PloS One, 15(11), e0241516.
- Judge-Ellis, T., & Wilson, T. R. (2017). Time and NP practice: Naming, claiming, and explaining the role of nurse practitioners. The Journal for Nurse Practitioners: JNP, 13(9), 583–589.
- Kelly, S., Martin, S., Kuhn, I., Cowan, A., Brayne, C., & Lafortune, L. (2016). Barriers and facilitators to the uptake and maintenance of healthy behaviours by people at mid-life: A rapid systematic review. PloS One, 11(1), e0145074.
- Khurana, L., Durand, E. M., Gary, S. T., Otero, A. V., Dumais, K. M., Beck, J., Zurakowski, D., … & Dallabrida, S. M. (2019). Mechanisms for improving diabetes patient-provider communication through optimal use of e-clinical technologies. Patient Preference and Adherence, 13, 981–992.
- Richardson, G. C., Derouin, A. L., Vorderstrasse, A. A., Hipkens, J., & Thompson, J. A. (2014). Nurse practitioner management of type 2 diabetes. The Permanente Journal, 18(2), e134–e140.
- Shrivastava, S. R., Shrivastava, P. S., & Ramasamy, J. (2013). Role of self-care in management of diabetes mellitus. Journal of Diabetes and Metabolic Disorders, 12(1), 14.
- Tai-Seale, M., McGuire, T. G., & Zhang, W. (2007). Time allocation in primary care office visits. Health Services Research, 42(5), 1871–1894.
- Welch, H. G., Chapko, M. K., James, K. E., Schwartz, L. M., & Woloshin, S. (1999). The role of patients and providers in the timing of follow-up visits. Telephone care study group. Journal of General Internal Medicine, 14(4), 223–229.
- Williams, J. S., Walker, R. J., Smalls, B. L., Hill, R., & Egede, L. E. (2016). Patient-centered care, glycemic control, diabetes self-care, and quality of life in adults with type 2 diabetes. Diabetes Technology & Therapeutics, 18(10), 644–649.