Communication competence, self-care behaviors and glucose control in patients with type 2 diabetes

Objective: To examine the relationship between physician communication competence and A1c control among Hispanics and non-Hispanics seen in primary care practices. Study design: Observational. Methods: Direct observation and audio-recording of patient-physician encounters by 155 Hispanic and non-Hispanic white patients seen by 40 physicians in 20 different primary care clinics. Audio-recordings were transcribed and coded to derive an overall communication competence score for the physician. An exit survey was administered to each patient to assess self-care activities and their medical record was abstracted for the most recent glycosylated hemoglobin (A1c) level. Results: Higher levels of communication competence were associated with lower levels of A1c for Hispanics, but not non-Hispanic white patients. Although communication competence was associated with better self-reported diet behaviors, diet was not associated with A1c control. Across all patients, higher levels of communication competence were associated with improved A1c control after controlling for age, ethnicity and diet adherence. Conclusions: Physician's communication competence may be more important for promoting clinical success in disadvantaged patients. Practice implications: Acquisition of communication competence skills may be an important component in interventions to eliminate Hispanic disparities in glucose control.