Clinicians, researchers and policy planners have recognized that despite the availability of effective medications and self-monitoring methods, normal metabolic control for a great proportion of patients with diabetes remains elusive, in large part because of non-adherence to treatment. Models of care, which focuses on improving patient-provider interactions, have been shown to be effective in improving adherence to therapies in patients with chronic illness. The goal of this 5-year Mentored Patient-Oriented Research Career Development Award is to enable the applicant to obtain the necessary skills and training to become an independent investigator in improving diabetes self-management by focusing on the health care relationship. This career development award will consist of coursework, mentorship, and supervised investigations focusing on: 1) understanding patient-provider relationship influences on diabetes self-care, using attachment theory as a model; 2) assessing cost and utilization and societal implications of poor patient-provider communication in diabetes care; and 3) developing and testing of high quality clinical interventions using relationship-based theoretical models to improve health care utilization, treatment adherence and outcomes in diabetes. Career development activities will be applied to four mentored research studies. In study 1, analyses of existing data sets from primary and tertiary care diabetes patients will test the hypothesis that the quality of the patient-provider relationship is associated with diabetes self-management. In study 2, a large longitudinal epidemiological study of primary care patients with diabetes will assess the impact of patient-provider communication on clinical outcomes and health care costs and utilization. In study 3, in-depth qualitative and quantitative assessment of type 2 diabetes patients will be conducted to assess how treatment adherence is influenced by patterns of patient-provider interactions. In Study 4, data from the first three studies will be integrated with career development training to develop and pilot test clinical interventions for improving care of diabetes. Study 4 will test the feasibility of conducting such interventions focusing on the patient-provider relationship in preparation for a clinical effectiveness trial (R-01 study). This award will help the applicant bridge the gap between theory-based research on the patient-provider relationship and dissemination of clinical and population-based interventions designed to improve the quality of the patient-provider relationship and self-care in diabetes. This K-23 award will provide crucial support for the applicant's ongoing development as an investigator, clinician, and educator in the area of diabetes care.
