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relationship on diabetes outcomes such as adherence and metabolic control It should be noted, however, that playing an active role in medical encounters and decision making may not be easily achieved for all patients (eg, Green eld et al, 1988) Poorer metabolic control has been associated with less patient involvement, less effective information-seeking behavior, and less exchange of opinions during of ce visits (Kaplan, Green eld, & Ware, 1989) Physicians provision of autonomy support (ie, providing choice to the patients, giving information, acknowledging emotions, and providing minimal pressure for patients to behave a certain way) has been related to better glycemic control, perceived competence, and autonomous motivation for adherence (G Williams, Freedman, & Deci, 1988).

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Randomized studies have found that interventions designed to increase patient participation in medical encounters lead to behavioral changes in the interactions with practitioners, fewer physical limitations, and improved glycemic control (Green eld et al, 1988; Rost, Flavin, Cole, & McGill, 1991) Green eld and colleagues (1988) developed an intervention consisting of two brief sessions in which patients were taught communication skills pertaining to information seeking, negotiation, focused question asking, and asserting control Patients medical charts were reviewed with them, and any perceived barriers to active participation were discussed and coping strategies suggested The patients who were randomized to the intervention group were twice as effective at eliciting information from the physician and were more active in the patient practitioner interaction Importantly, these patients reported fewer functional limitations and better glycemic control at follow-up.

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The authors state that further research is needed to determine whether the noted improvements are related to increased information that patients obtained in the visit or to the increased involvement Rost et al (1991) investigated whether similar improvements could be achieved by adding a patient activation component to an inpatient diabetes education program Patient activation training involved reviewing their medical charts and obstacles to active involvement, writing down questions for practitioners, and improving communication Patients who were randomized to the activation condition were more active in their discharge visit and showed a trend for increased decision-making behaviors This group reported fewer physical limitations in activities of daily living four months later and some improvements in metabolic control Importantly, the physicians satisfaction was not negatively affected by the interaction The active role and personal responsibility of patients are major tenets of patient empowerment programs (R Anderson et al, 1995) R.

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java data matrix barcode reader