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Abstract
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). 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. 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. 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 racial/ethnic differences in diagnosis.
Acknowledgments
We would like to thank data consultants Bruce Folck and Meng Lu at the Kaiser Permanente Division of Research for assistance with data linkages. Dr. Adams conceptualized the work, interpreted the data, and drafted the article. Dr. Parker conducted the analysis and edited/revised the article. Drs. Moffet, Jaffe, Schillinger, Callaghan, Piette, Adler, Bauer, and Karter contributed to the conceptualization of the article, the interpretation of the data, and revisions/edits to the article. Dr. Karter also provided the data.
Data Access: We are not free to release participants’ personal data under our promise to them regarding confidentiality. However, the Diabetes Study of Northern California (DISTANCE) study team is interested in collaborations with external researchers. DISTANCE investigators are particularly interested in comparing processes and outcomes in this insured population with uniform access to care to disparities observed in population-based samples, in which quality and access to care vary widely by social strata. Requests for collaboration must be submitted to the director of the central coordinating center. Before collaborations can be initiated, proposals require review and approval by the Publications and Presentations Committee. This committee was formed to (a) ensure accurate, uniform, timely, and high-quality reporting of DISTANCE findings; (b) preserve the scientific integrity of the study; and (c) safeguard the rights and confidentiality of participants. For more information, please contact [email protected].
Funding
Funding for this study was provided by the National Institute of Diabetes and Digestive and Kidney Diseases (R01DK081796, RC1 DK086178, R01DK080726, R01DK065664, P30 DK092924) and the Division of Diabetes Translation of the Centers for Disease Control and Prevention (U58 DP002641). This work was partially supported through a Patient-Centered Outcomes Research Institute Assessment of Prevention, Diagnosis, and Treatment Options Program Award (CE-1304-7250).
All statements in this report, including its findings and conclusions, are solely our own and do not necessarily represent the views of the Patient-Centered Outcomes Research Institute, its Board of Governors, or its Methodology Committee.