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OBJECTIVE: Patients' self‐management practices have substantial consequences on morbidity and mortality in diabetes. While the quality of patient‐physician relations has been associated with improved health outcomes and functional status, little is known about the impact of different patient‐physician interaction styles on patients' diabetes self‐management. This study assessed the influence of patients' evaluation of their physicians' participatory decision‐making style, rating of physician communication, and reported understanding of diabetes self‐care on their self‐reported diabetes management. DESIGN: We surveyed 2,000 patients receiving diabetes care across 25 Veterans' Affairs facilities. We measured patients' evaluation of provider participatory decision making with a 4‐item scale (Provider Participatory Decision‐making Style [PDMstyle]; α = 0.96), rating of providers' communication with a 5‐item scale (Provider Communication [PCOM]; α = 0.93), understanding of diabetes self‐care with an 8‐item scale (α = 0.90), and patients' completion of diabetes self‐care activities (self‐management) in 5 domains (α = 0.68). Using multivariable linear regression, we examined self‐management with the independent associations of PDMstyle, PCOM, and Understanding. RESULTS: Sixty‐six percent of the sample completed the surveys (N = 1,314). Higher ratings in PDMstyle and PCOM were each associated with higher self‐management assessments (P < .01 in all models). When modeled together, PCOM remained a significant independent predictor of self‐management (standardized β: 0.18; P < .001), but PDMstyle became nonsignificant. Adding Understanding to the model diminished the unique effect of PCOM in predicting self‐management (standardized β: 0.10; P = .004). Understanding was strongly and independently associated with self‐management (standardized β: 0.25; P < .001). CONCLUSION: For these patients, ratings of providers' communication effectiveness were more important than a participatory decision‐making style in predicting diabetes self‐management. Reported understanding of self‐care behaviors was highly predictive of and attenuated the effect of both PDMstyle and PCOM on self‐management, raising the possibility that both provider styles enhance self‐management through increased patient understanding or self‐confidence.

Hogan et al analyze health care services utilization in the emergency department for blacks and whites to note any differences. Several studies have shown discrepancies in a variety of health care services provided for blacks compared with whites.

To obtain better understanding of the nature and cost of health care related to human immunodeficiency virus (HIV) infection, medical payment records were analyzed for 204 men, women, and children older than 60 months who had indications of HIV infection. The records were those of Michigan Medicaid, the General Assistance Medical Program, and the Resident County Hospitalization Program, with service dates on or after January 1, 1984, and which were processed by November 30, 1987. Patient payment records were coded according to whether the patient's condition was considered to be pre-HIV, HIV unrelated, possibly HIV related, or HIV related. Average monthly payments were found to be $150 for pre-HIV patient payment records, $114 for those HIV unrelated, $57 for those possibly related, and $1,213 for those related to HIV infection. HIV-related monthly payments rose from about $1,500 per month in the period 3 months prior to the patient's death to more than $8,000 in the last month of life. Men were found to have twice as many claims as women, and men's claims cost about three times as much. A higher percentage of women than men (91 percent versus 37 percent) received pre-HIV paid services, indicating a higher percentage of women were at least initially receiving Medicaid for reasons other than an HIV-related disability. Diagnostic categories that accounted for the bulk of the HIV-related health care utilization included infectious and parasitic diseases, acquired immunodeficiency syndrome, diseases of the respiratory system, and non-HIV-specific immunity disorders. Inpatient hospitalization accounted for more than 75 percent of the payments, followed by physician costs (11 percent), pharmacy costs (5 percent), and outpatient costs (3 percent). A total of 45, or about 22 percent of the recipients, received zidovudine (AZT) prescriptions at an average monthly cost of $404.