(1) The report calls for ”recognizing the patient as the source of control and customizing care based on patient needs and values.” Clinicians need to discuss time with patients, to find out how much time is available and the pressures on that time. Such discussions are consistent with the Chronic Care Model, which recommends clinicians “elicit and review data concerning patients’ perspectives” and “help patients to set goals and solve problems.”15
(2) The report calls for evidence-based care and recommends that patients “have unfettered access to their own medical information and to clinical knowledge.” Research is needed to identify the tasks that yield the most improvement in symptoms and health for particular patients. Such “time-effectiveness studies” would show which tasks make the best use of self-care time for patients with specific symptoms and complications. Until such data are available, physicians must rely on clinical experience to help guide patients.
(3) The report calls for “continuous decrease in waste” noting that “the health system should not waste resources or patient time” (italics added). When self-management requires a lot of time, that time deserves to be used carefully and well. We suggest that self-care guidelines consider time requirements. Where they are onerous, ways should be found to reduce them or to help patients set priorities.
Diabetes self-management is an essential component of good care. The time patients devote to self-care deserves serious attention in efforts to improve the quality of care.
Acknowledgements
The authors thank Ann Marie DeLisi, Patricia Prata, Dorothy Caputo, Christine Bazzarre, Ruth Ann Petzinger, Lee Ann Redfern, Carol Salas, and Carolyn Swither, the certified diabetes educators who participated in our focus group.
Corresponding author
Monika M. Safford, MD, MT 643, 1717 11th Avenue South, Birmingham, AL 35294-4410. Email: msafford@uab.edu.