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Communication Barriers and the Clinical Recognition of Diabetic Peripheral Neuropathy in a Diverse Cohort of Adults: The DISTANCE Study
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Details:
  • Pubmed ID:
    27116591
  • Pubmed Central ID:
    PMC4920056
  • Description:
    Objective

    The purpose of this study was to explore communication barriers as independent predictors and potential mediators of variation in clinical recognition of diabetic peripheral neuropathy (DPN).

    Methods

    In this cross-sectional analysis, we estimated the likelihood of having a DPN diagnosis among 4,436 patients with DPN symptoms. We controlled for symptom frequency, demographic and clinical characteristics, and visit frequency using a modified Poisson regression model. We then evaluated 4 communication barriers as independent predictors of clinical documentation and as possible mediators of racial/ethnic differences: difficulty speaking English, not talking to one’s doctor about pain, limited health literacy, and reports of suboptimal patient-provider communication.

    Results

    Difficulty speaking English and not talking with one’s doctor about pain were independently associated with not having a diagnosis, though limited health literacy and suboptimal patient-provider communication were not. Limited English proficiency partially attenuated, but did not fully explain, racial/ethnic differences in clinical documentation among Chinese, Latino and Filipino patients.

    Conclusions

    Providers should be encouraged to talk with their patients about DPN symptoms, and health systems should consider enhancing strategies to improve timely clinical recognition of DPN among patients who have difficult speaking English. More work is needed to understand persistent race/ethnic differences in diagnosis.

  • Document Type:
  • Collection(s):
  • Funding:
    U58 DP002641/DP/NCCDPHP CDC HHS/United States
    R01 DK065664/DK/NIDDK NIH HHS/United States
    RC1 DK086178/DK/NIDDK NIH HHS/United States
    R01 DK080726/DK/NIDDK NIH HHS/United States
    P30 DK092924/DK/NIDDK NIH HHS/United States
    P30 DK020572/DK/NIDDK NIH HHS/United States
    R01 DK081796/DK/NIDDK NIH HHS/United States
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