Physician Trust Key To Diabetes Care

A new study by Kaiser Permanente researchers concludes that patients with chronic conditions in a potentially fragile mental state are more likely to adhere to a part of their medication regimen if they have a strong bond of trust with their physicians and are able to communicate with them.

The study focused on 1,523 Kaiser enrollees in Northern California with adult onset diabetes who were also being treated for depression between 2006 and 2010. The patients were thoroughly interviewed regarding their relationship with their primary care physician and the level of trust they had with that provider.

Altogether, 96% of the patients filled their antidepressant prescriptions after they were dispensed by their physician. However, more than 6% of patients who said they felt they were not included in treatment decisions by their physician did not fill it, compared to less than 3% who felt they were included in the decisionmaking process.

Among those who had their prescription dispensed, those who had less trust in their physician were a third more likely to never refill it, and have poor medication adherence overall.

The findings are significant, researchers say, not only because of the prevalence of adult onset diabetes in the United States, but because of its potential link to depression as well.

“It is striking how strongly providers’ relationships with their patients, particularly establishing trust and the use of shared decision-making, influenced whether patients became ongoing users of the medications prescribed for depression,” said Andrew Karter, a Kaiser research scientist and the study's senior author.  

Karter added that diabetics with depression are far more likely to suffer complications such as heart disease and dementia and die sooner, making adherence to medications that lighten their mood an important part of diabetes management.

Although no studies have been conducted regarding the overlap between the diabetes and depression, it is likely significant given the numbers who have been diagnosed with either affliction to date. 

About 26 million Americans currently have diabetes, according to data from the American Diabetes Association. And the Centers for Disease Control and Prevention estimate that about 10% of the U.S. population -- about 30 million in total -- have suffered from depression in their lives. 

Adult onset diabetes also tends to correlate with obesity, which in itself is often linked to depression. The Kaiser cohort represents about 7.5% of a population of Northern California diabetes patients the organization has been studying for the past decade.

The study joins a mounting pile of research strongly suggesting that doctors should listen more closely to their patients.

“Because the quality of provider communication is potentially modifiable, this serves as a promising target for interventions to improve adherence and therefore help patients get an adequate course of antidepressant therapy,” said Amy Bauer, M.D., of the University of Washington School of Medicine, which conducted the study jointly with Kaiser. 

The study is part of a larger long-term examination of more than 20,000 Kaiser enrollees in Northern California who have diabetes that is being funded by the National Institutes of Health.

The findings were published in the most recent issue of the Journal of General Internal Medicine.

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To Treat Patients, Relate To Them