671-P: Patients Feel Responsible for Self-Care and Understand That Clinic Visits Are Vital, but Want More Interim Support

Routine clinic visits provide intermittent opportunity for patients and providers to review patient status and adjust diabetes management. Yet little is known about patient views of the clinic role in managing diabetes. Purpose: To examine patient perceptions of the role of clinic visits. Methods: A research nurse conducted semi-structured, audiotaped interviews with a convenience sample of 25 participants from a study of a coaching intervention in an urban diabetes clinic. Participants had A1c ;>7, at least two clinic visits and a prescription for insulin or high dose oral agents. Two qualitative researchers analyzed transcript content to identify themes on the clinic role in diabetes management. Results: The population was 96% black, 52% female, with mean age of 56 years and A1c of 8.3%. Most participants (76%) reported household incomes < $15,000/year. Four main perception themes were identified: (1) “It’s on me.” (2) being held accountable (3) management prescription and (4) supportive relationships. Almost all felt responsible for following their diabetes management plans (88%). They perceived that clinic encounters provided assessment/feedback of their diabetes status and management and gave them incentive to improve self-care. They often expressed faith in providers and a sense that providers would give them the guidance to improve health. Some patients reported collaboration (36%) with providers, and they often valued nurse educators as integral to personalized, holistic care. Participants lamented visit time constraints and lack of support between visits. Yet some overcame these barriers by seeking out information on their own and preparing for visits ahead of time. Conclusions: Diabetes requires a significant degree of self-management. Patients view clinic encounters as an important component of diabetes care that supports their self-management but desire more contact in and between visits.