L. Du Pasquier-fediaevsky et N. Tubiana-rufi, Discordance between physician and adolescent assessments of adherence to treatment - influence of HbA(1c) level, DIABET CARE, 22(9), 1999, pp. 1445-1449
OBJECTIVE - To compare the subjective assessments (perceptions) of physicia
ns and adolescent diabetic patients on the adolescents' adherence to treatm
ent and to test the hypothesis that the HbA(1c), level influences physician
s' perceptions.
RESEARCH DESIGN AND METHODS - In a multicenter cross-sectional survey, 143
adolescents with diabetes (mean age 14.6 years) auto-assessed, while their
pediatricians independently assessed, the level of adherence to treatment o
n a four-point scale. Scores of adherence given by a validated scale and me
tabolic control (HbA(1c),) were compared according to those assessments.
RESULTS - Agreement between the adherence perceptions from adolescents and
physicians was low (kappa = 0.23), and adolescents scored significantly hig
her (P < 0.001). Mean adherence score to diabetes treatment was significant
ly higher when the adolescents' perception of their self-care behaviors was
good than when it was poor (P = 0.01), but did not significantly differ ac
cording to physicians' perception. Mean HbA(1c), level was significantly lo
wer when the self-care behavior perception was good than when it was poor,
both for the adolescents (P = 0.02) and for the physicians (P < 0.001). Mul
tivariate analyses showed that only the adherence scale score was significa
ntly associated with the adolescents' perception (P = 0.015), whereas only
HMI, level was significantly associated with the physicians' perception (P
= 0.0008).
CONCLUSIONS - By identifying the possible discrepancy between their own ass
essment of adherence and that of adolescents, and by avoiding the systemati
c attribution of poor metabolic control to poor adherence, physicians could
generate a more confident and collaborative relationship with diabetic ado
lescents and therefore facilitate adolescents' self-management.