‘Teach-back’ communication may lower patients’ risk for diabetes complications, hospitalizations

A simple doctor-patient communication technique known as “teach-back” may lower the risk of health complications, hospitalizations and health care costs for patients with diabetes, according to a new University of Florida study published Friday in the Journal of the American Board of Family Medicine.

With teach-back, health care providers ask patients to repeat back information to them during a visit. This helps the provider gauge how well the patient understands health information, such as treatment plans, medications and disease self-management. If the patient has poor recall or misunderstanding, providers can repeat, clarify or tailor information.

In a previous UF study, Young-Rock Hong, Ph.D., M.P.H., an assistant professor in the department of health services research, management and policy at the UF College of Public Health and Health Professions, and colleagues, found that when patients with high blood pressure, Type 2 diabetes and heart disease practiced teach-back communication with their physician, they were significantly less likely to require hospitalization for those conditions.

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In the new study, the UF team focused on how teach-back may affect outcomes for patients with Type 1 and Type 2 diabetes, conditions that require active patient self-management and continuous care by health care providers to prevent other health complications, such as heart disease and some cancers.

The release of the findings during November, which is National Diabetes Month, helps highlight the efforts underway to get people to take a more active role in managing a disease that affects more than 34 million Americans. Another 88 million, roughly one in three people, have prediabetes.

“Despite the increasing availability of treatment and preventive options, many patients with diabetes do not meet evidence-based management goals and continue to develop preventable complications,” said Hong, the study’s lead investigator and a member of the UF Health Cancer Center.

Using the 2011 to 2016 Longitudinal Medical Expenditure Panel Survey, which is administered annually by the U.S. Agency for Healthcare Research and Quality, the team analyzed data from 2,900 adults age 18 and older with a confirmed diagnosis of Type 1 or Type 2 diabetes. They tracked diabetes complications, hospitalizations for diabetes complications and health care costs for a year. Patients who used teach-back with their provider were 20% less likely to experience health complications from their diabetes, including heart disease or kidney or eye problems, and were less likely to be hospitalized because of diabetic complications.

The researchers also noted health care savings of between $1,400 and $1,700 per patient among patients who used teach-back. If teach-back were fully implemented among all Americans with diabetes, this could lead to annual savings of billions of dollars in health care expenditures, the researchers say.

Despite benefits in quality of care, health outcomes and cost savings, the researchers found only 25% of patients in the study population had consistent teach-back experience in their doctor visits. So why aren’t more physicians using teach-back with their patients? Barriers may include lack of time during the visit or skepticism about its effectiveness. Some doctors may fear that asking patients to teach-back may be perceived as being paternalistic, said the study’s senior author Arch G. Mainous III, Ph.D., a professor in the department of health services research, management and policy.

“Consequently, many doctors may feel that teach-back could be interpreted by the patient as a strategy that makes them look dumb in the eyes of the doctor,” Mainous said. “The doctor may want to avoid this dynamic of seemingly ‘quizzing’ the patient.”

The researchers hope their findings help encourage widespread adoption of teach-back by health care providers, but even if providers don’t include teach-back in their visits, patients still have a role to play in effective communication, Hong said.

“Patients can be proactive in patient-provider communication and check and confirm their understanding with their providers,” he said. “It’s about your health, so I think patients or caregivers should have a mindset of ‘I want to make sure I understood all this information correctly’ whenever they are interacting with providers.”

In addition to Hong and Mainous, the study team included Jinhai Huo, Ph.D., M.D., associate director of U.S. health economics and outcomes research at Bristol-Myers Squibb; Ara Jo, Ph.D., an assistant professors in the department of health services research, management and policy, and Michelle Cardel, Ph.D., R.D., an assistant professor in the department of health outcomes and biomedical informatics at the UF College of Medicine.

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