The patient-provider relationship: Attachment theory and adherence to treatment in diabetes

Objective: Lack of adherence to diabetic self-management regimens is associ ated with a high risk of diabetes complications. Previous research has show n that the quality of the patient-provider relationship is associated with adherence to diabetes treatment. This study attempts to improve understandi ng of both patient and provider factors involved in lack of adherence to tr eatment in diabetic patients by using the conceptual model of attachment th eory. Method: Instruments that assessed attachment, treatment adherence, depressi on, diabetes severity, patient-provider communication, and demographic data were administered to 367 patients with type 1 and 2 diabetes in a health m aintenance organization primary care setting. Glucose control, medical como rbidity, and adherence to medications and clinic appointments were determin ed from automated data. Analyses of covariance were used to determine if at tachment style and quality of patient-provider communication were associate d with adherence to treatment. Results: Patients who exhibited dismissing attachment had significantly wor se glucose control than patients with preoccupied or secure attachment. An interaction between attachment and communication quality was significantly associated with glycosylated hemoglobin (Hb A(1c)) levels. Among the patien ts with a dismissing attachment style, there was a significant difference i n glycosylated hemoglobin levels between those who rated their patient-prov ider communication as poor (mean = 8.50%, SD = 1.55%) and those who rated t his communication as good (mean = 7.49%, SD = 1.33%). Among all patients wh o were taking oral hypoglycemics, adherence to medications and glucose moni toring was significantly worse in patients who exhibited dismissing attachm ent and rated their patient-provider communication as poor. Conclusions: Dismissing attachment in the setting of poor patient-provider communication is associated with poorer treatment adherence in patients wit h diabetes.