‘Meaningful meetings’ – A pilot study to improve the diabetes clinical encounter for nurses and patients using The Diabetes MyQuest Consultation Tool©

Abstract

Background: The clinical encounter between nurse and patient is an important and growing strategy in the management of Type 2 Diabetes Mellitus in primary care settings. However, due to time pressures, lack of knowledge, training and skills, the meeting can be a frustrating experience for both the nurse and the patient, and the potential to improve diabetes self-management may be sub-optimal. The Diabetes MyQuest Consultation Tool© (DMCT©) has been designed in collaboration with both patients and nurses to improve the consultation by using a person centred approach, identifying psychological problems which may affect self-management, and promoting a more meaningful meeting between both parties. Methods: The DMCT© was piloted using a randomised control trial to gauge how feasible, practical and acceptable the application of the questionnaire would be in primary care settings to both nurses and patients. The pilot further explored whether the tool would promote diabetes knowledge, increase consultation satisfaction and improve diabetes self-efficacy in patients compared to usual care. The study used a mixed methods approach of qualitative interviews and three measures: a diabetes knowledge questionnaire (DKQ); satisfaction with the consultation questionnaire (DCPNI) and a diabetes empowerment scale (DES-SF). All participants were given the WHO-5 Well-Being Index to complete. Results: The age range of the sample (n = 106) was 40–90 years (m = 67 years) and comprised of 66 males, and 40 females. The average duration of diabetes was 9 years, and at the pre-study visit the mean values for BMI, cholesterol and HbA1c were 30.7 kg/m2; 4.2 mmols/l and 55.0 mmols/mol, respectively. Fifty-six patients were randomised to use the DMCT© tool as part of their consultation. There were no significant differences to HbA1c, Cholesterol or BMI between the control and intervention groups. There were minor but noted improvements in the control group between the pre and post measure for DKQ (mean increase 1.10; p > 0.001), whereas the intervention group demonstrated significant improved changes for all three measures: DKQ (mean increase = 1.41; p > 0.000), DCPNI (mean increase = 2.1; p > 0.002; DES-SF mean increase = 2.5; p > 0.000). All participants completed the WHO-5 Well-Being Index with 34% (n = 36) scoring on or below the clinical cut-off score of 13 – indicating a need for further depression screening. Conclusion: Patients in the intervention group overwhelmingly found the DMCT© tool helpful with their diabetes consultations and nurses’ derived good practical use from the tool in determining the kinds of issues patients may have. The tool seems to have promoted a more patient centred approach to the consultation, empowering patients to discuss management aspects relevant to their individual needs. The results of this pilot indicate that the DMCT© is a feasible, practical tool for use by both patients and nurses. A larger and longer scale study in varied primary care settings to determine further efficacy and using measurable hard end points is now warranted.