The Impact of Patient-Centered versus Didactic Education Programs in Chronic Patients by Severity: The Case of Type 2 Diabetes Mellitus

Abstract

Background: Education leads to better health-related decisions and protective behaviors, being especially important for patients with chronic conditions. Self-management education programs have been shown to be beneficial for patients with different chronic conditions and to have a higher impact on health outcomes than does didactic education.

Objective: To investigate improvements in glycemic control (measured by glycated hemoglobin A1c) in patients with type 2 diabetes mellitus.

Methods: Our comparative trial involved one group of patients receiving patient-centered education and another receiving didactic education. We dealt with selection bias issues, estimated the different impact of both programs, and validated our analysis using quantile regression techniques.

Results: We found evidence of better mean glycemic control in patients receiving the patient-centered program, which engaged better patients. Nevertheless, that differential impact is nonmonotonic. Patients initially at the healthy range at the patient-centered program maintained their condition better. Patients close to, but not within, the healthy range benefited equally from attending either program. Patients with very high glycemic level benefited significantly more from attending the patient-centered program. Finally, patients with the worst initial glycemic control (far from the healthy range) improved equally their diabetic condition, regardless of which program they attended.

Conclusions: Different patients are sensitive to different categories of education programs. The optimal, cost-effective design of preventative programs for patients with chronic conditions needs to account for the different impact in different "patient categories." This implies stratifying patients and providing the appropriate preventative education program, or looking for alternative policy implementations for unresponsive patients who have the most severe condition and are the most costly.

Keywords: chronic disease self-management; patient-centered education; quantile regression.