Physician-Patient Relationships and Their Effect on T2DM Patient Treatment Adherence

Physician-Patient Relationships and Their Effect on T2DM Patient Treatment Adherence by Cynthia Schmidt MA, Amberton University, 2001 BS, Boston College, 1981 Dissertation Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy Clinical Psychology Walden University August 2018 Abstract Type 2 diabetes (T2DM) is a health epidemic that continues to worsen. A major concern is that treatment adherence rates hover around 50%, despite the introduction of new medications, treatments, and technology. Lack of adherence by patients can lead to complications like blindness, kidney disease, and amputations. While there have been many studies conducted to evaluate patient factors related to adherence, fewer studies have been conducted to evaluate the role of the physician-patient relationship. The purpose of this study was to examine the correlation between the physician-patient relationship and patient treatment adherence, and examine the moderators of age, education, ethnicity, and income. Gender was included as a moderator in a secondary analysis. Two theories formed the theoretical framework of this study: biopsychosocial model and self-efficacy theory. This quantitative nonexperimental study was completed with survey data collected from 92 participants in the United States ages 18 or older who were under treatment for T2DM for at least a year, and who had seen their physician at least once in the previous year. Correlational and regression analyses were conducted using data from the modified Clinician and Group Survey and the Diabetes Management Self-Questionnaire. The physician-patient relationship predicted treatment adherence, and gender moderated the relationship. These findings suggest the importance of the physician-patient relationship as a factor in patient treatment adherence. This has important implications for social change because an understanding of which physician factors lead to treatment adherence may help improve patient outcomes, reduce T2DM complications, improve patient quality of life, and reduce healthcare costs.Type 2 diabetes (T2DM) is a health epidemic that continues to worsen. A major concern is that treatment adherence rates hover around 50%, despite the introduction of new medications, treatments, and technology. Lack of adherence by patients can lead to complications like blindness, kidney disease, and amputations. While there have been many studies conducted to evaluate patient factors related to adherence, fewer studies have been conducted to evaluate the role of the physician-patient relationship. The purpose of this study was to examine the correlation between the physician-patient relationship and patient treatment adherence, and examine the moderators of age, education, ethnicity, and income. Gender was included as a moderator in a secondary analysis. Two theories formed the theoretical framework of this study: biopsychosocial model and self-efficacy theory. This quantitative nonexperimental study was completed with survey data collected from 92 participants in the United States ages 18 or older who were under treatment for T2DM for at least a year, and who had seen their physician at least once in the previous year. Correlational and regression analyses were conducted using data from the modified Clinician and Group Survey and the Diabetes Management Self-Questionnaire. The physician-patient relationship predicted treatment adherence, and gender moderated the relationship. These findings suggest the importance of the physician-patient relationship as a factor in patient treatment adherence. This has important implications for social change because an understanding of which physician factors lead to treatment adherence may help improve patient outcomes, reduce T2DM complications, improve patient quality of life, and reduce healthcare costs. Physician-Patient Relationships and Their Effect on T2DM Patient Treatment Adherence by Cynthia Schmidt MA, Amberton University, 2001 BS, Boston College, 1981 Dissertation Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy Clinical Psychology Walden University August 2018 Dedication This dissertation is dedicated to my loving and supportive husband Fred and my precious children, Christofer and Lauren. They were there with me every step of the way. I still cherish the note of support that my daughter Lauren wrote to me after a particularly challenging week. Acknowledgments I would like to express my sincere gratitude to Dr. Silvia Bigatti, my chairperson whose unwavering positive support, suggestions, and guidance was instrumental in helping me throughout the dissertation process. I would also like to thank my committee members Dr. Ellen Levine and Dr. Patty Devine who were also there to guide me through this long, but rewarding journey. Dr. Levine helped me improve my research design and writing skills. Dr. Devine, my university reviewer was supportive, timely, and provided helpful comments. I would also like to express my love and gratitude to my friend and mentor Dr. Edie Eger who started me on this journey. Due to a chance meeting, a bad rainstorm, and a long car ride, Edie was able to take this time to encourage me to work on my doctorate in psychology. This dissertation would not be possible without the study participants. I am very grateful that they took the time to participate in my study and also Dr. Schmitt who graciously allowed me to use his instrument for my dissertation. Another group that I would like to thank are the individuals who would appear just when I needed them there during this process by encouraging me, praying for me, and refusing to let me give up on my dreams. Finally, I would like to thank my classmates who were always there to support me, as well as, give me helpful advice on how to navigate the dissertation journey.