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129 Patient-clinician collaboration in making care fit: a qualitative analysis of clinical consultations in diabetes care
  1. Martha Kidanemariam1,
  2. Matthijs Graner2,
  3. Willem Jan W Bos3,4,
  4. Marielle A Schroijen3,
  5. Eelco JPDe Koning3,
  6. Anne M Stiggelbout1,5,
  7. Victor M Montori6,
  8. Arwen H Pieterse1,
  9. Marleen Kunneman1,6
  1. 1Medical Decision making, Biomedical Data Sciences, Leiden University Medical Centre, Leiden, The Netherlands
  2. 2The ééndiabetes Foundation, Amsterdam, The Netherlands
  3. 3Department of Internal Medicine, Leiden University Medical Centre, Leiden, The Netherlands
  4. 4Department of Internal Medicine, Sint-Antonius Hospital, Nieuwegein, The Netherlands
  5. 5Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, the Netherlands
  6. 6Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota, USA


Introduction Patient-clinician collaboration to make care fit has been described to include nine relevant dimensions, based on expert opinion and a literature review. The purpose of this study was to confirm described dimensions of making care fit and explore how patients and clinicians collaborate to make care fit in clinical practice.

Methods As part of an ongoing study, we audiotaped and transcribed patient-clinician consultations in diabetes care. We purposively selected consultations based on participants’ demographical, biomedical, and biographical characteristics. We analyzed transcripts using reflexive thematic analysis. We combined a deductive and inductive approach, using the pre-described dimensions of making care fit and adding new (sub-)dimensions when pertinent.

Results We analyzed 24 clinical consultations. Our data confirmed the nine previously described dimensions and provided eight new sub-dimensions of making care fit with examples from clinical practice (problematic situation, influence of devices, sense of options, shared agenda setting, lack of collaboration, clinician context, adapting to changing organization of care, and possibility to reconsider, see table 1).

Discussion Our study confirmed, specified, and enriched the conceptualization of making care fit through practice examples. We observed patient-clinician collaboration in the exploration of patients’ context, and by responsively changing, adapting, or maintaining care plans.

Conclusion Our findings provide insights in important aspects of patient-clinician collaboration. Ultimately, this would lead to optimal design of care plans that fit well in each patient’s life.

Abstract 129 Table 1

Thematic map (dimensions and subdimensions of making care fit) with exemplary quotes

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