To assess whether a brief agenda-setting tool could align primary care for adults with type 2 diabetes with patients’ priorities and goals.
Approach:
Design and setting: The QBSafe cluster randomized clinical trial enrolled 11 clinicians and 143 adults with type 2 diabetes and HbA1c above 8% at a federally qualified health center in New Haven, Connecticut.
Intervention: Patients selected up to three of 14 conversation cards covering diabetes-related concerns; clinicians discussed the selected priorities at the start of the usual visit. Controls received usual care.
Assessment: At six months, investigators assessed illness and treatment intrusiveness, HbA1c, treatment burden, diabetes distress, quality of life, medication adherence, medication changes, and clinician-reported outcomes.
Key Findings:
The intervention did not significantly improve illness and treatment intrusiveness, HbA1c, treatment burden, diabetes distress, or quality of life compared with usual care.
Intervention-group clinicians reported greater encounter satisfaction and confidence in addressing patients’ concerns.
Medication adherence was higher in the intervention group than in controls (77.2% vs 64.6%); diabetes medication changes were also more frequent (33.8% vs 23.2%).
Visit duration did not increase, and cards were discussed during the first half of 88.9% of intervention visits.
Interpretation:
The article describes the tool as a feasible way to bring patients’ priorities into routine visits and notes signals of change in clinician experience and care processes. It argues that eliciting priorities alone may not provide the resources needed to address them, and presents the tool as an entry point to broader, ongoing support.
Limitations:
The intervention did not significantly improve illness and treatment intrusiveness, HbA1c, treatment burden, diabetes distress, or quality of life at six months.
Conclusion:
The article calls for agenda-setting tools to be connected with responsive clinical and community support, potentially including pharmacists, diabetes educators, behavioral health clinicians, community health workers, and care coordinators.
