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Thesis_Becca_FINAL_5-3-18.pdf (763.57 KB)

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Factors that Influence Physician Referral to Diabetes Self-Management Education in Patients with Type 2 Diabetes

Panak, Rebekah L
http://orcid.org/0000-0002-5383-5760
http://rave.ohiolink.edu/etdc/view?acc_num=mco152535252247564

Abstract Details

2018, Master of Science (MS), University of Toledo, Pharmaceutical Sciences (Health Outcomes and Socioeconomic Sciences).
Objectives: To determine the development of physician likelihood to refer based off the conceptual meaning of the hierarchical arrangement of items. To examine relationships between predictors* and the likelihood of referring patients to DSME programs. To determine the predictors* of physician likelihood to refer patients to DSME programs. To assess the likelihood of referral to DSME among practice specialties. *Predictors include: age, sex, practice specialty (family/general practitioner, internal medicine, endocrinology, or other), practice setting (hospital, medical group, private practice, or other), percentage of patients with diabetes seen monthly, attitude toward referring to DSME, social norm toward referring to DSME, and perceived behavioral control toward referring to DSME. Methods: Rasch analysis was used to calibrate the survey instrument and asses development of likelihood to refer. Pearson’s correlation was performed to assess relationships among predictors and likelihood of physician referral. A linear regression was used to determine predictors of physician likelihood to refer. After analysis and assessing responses, it was determined additional post hoc analysis was needed. One-way ANOVA was conducted to assess the likelihood of referral among provider types and practice settings. Results: Some attitudes and aspects of self-efficacy may be critical antecedents of intention to refer patients with type 2 diabetes to DSME. However, no conceptually meaningful arrangement of items was identified when assessing development of likelihood to refer. Physician intent to refer patients to DSME demonstrated a moderately positive relationship with attitude, subjective norm, and perceived behavioral control (r = 0.369, 0.339, 0.478, respectively, p < 0.001 all). Provider type was found to have a weak negative relationship with intent (r = -.123, p = 0.013) and perceived behavioral control (r = -.153, p = 0.002). Percentage of patients with diabetes had a weak a positive relationship with intent to refer (r = .117, p = 0.018) and perceived behavioral control (r = .101, p = 0.041). Age had a weak negative relationship with perceived behavioral control (r = -.133, p = 0.007) and sex had a weak positive relationship with attitudes (r = .162, p = 0.001). Overall, the model explained 31.9% of variance in intention to refer to DSME. Percent of patients seen monthly with diabetes contributed a small amount to the model (ß = 0.104, p = 0.018). No other demographic factors were found to be statistically significant. Attitudes (ß = .341, p = 0.013) and perceived behavioral control (ß = .447, p < 0.001) also significantly contributed to the model. Subjective norms were not found to be a significant predictor of physician intent. One-way ANOVA was statistically significant (F = 4.998, p = 0.001). Post hoc analysis identified physicians who selected “other” for provider type had a statistically significant difference in intention to refer than the provider types of interest to the study. No difference was found in intention to refer among any other provider types. Conclusion: Despite how commonplace referrals are, there is substantial variation in how and when physicians choose to refer to DSME. Attitudes and perceived behavioral control had a moderate, positive effect on the variation in physician intent to refer patients with type 2 diabetes to DSME. Perceived behavioral control had the largest impact on physician intent. Percent of patients had a small positive impact. Overall, physicians’ attitudes toward the benefits of referring a patient with type 2 diabetes to DSME were positive. There was no statistically significant difference in intention to refer among provider types of interest (general/family physicians, internal medicine physicians, endocrinologists).
Sharrel Pinto, PhD (Committee Chair)
Stone Gregory, PhD (Committee Member)
Puffer Cindy , RPh (Committee Member)
133 p.
Behavioral Sciences; Behaviorial Sciences; Health; Health Care; Health Care Management; Health Education; Health Sciences; Medicine; Pharmacy Sciences; Public Health Education; Social Research
Diabetes self-management education; DSME; diabetes education; physician; provider; refer; referral; theory of planned behavior; type 2 diabetes

Recommended Citations

Citations

  • Panak, R. L. (2018). Factors that Influence Physician Referral to Diabetes Self-Management Education in Patients with Type 2 Diabetes [Master's thesis, University of Toledo]. OhioLINK Electronic Theses and Dissertations Center. http://rave.ohiolink.edu/etdc/view?acc_num=mco152535252247564

    APA Style (7th edition)

  • Panak, Rebekah. Factors that Influence Physician Referral to Diabetes Self-Management Education in Patients with Type 2 Diabetes. 2018. University of Toledo, Master's thesis. OhioLINK Electronic Theses and Dissertations Center, http://rave.ohiolink.edu/etdc/view?acc_num=mco152535252247564.

    MLA Style (8th edition)

  • Panak, Rebekah. "Factors that Influence Physician Referral to Diabetes Self-Management Education in Patients with Type 2 Diabetes." Master's thesis, University of Toledo, 2018. http://rave.ohiolink.edu/etdc/view?acc_num=mco152535252247564

    Chicago Manual of Style (17th edition)

mco152535252247564
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This open access ETD is published by University of Toledo Health Science Campus and OhioLINK.