Patient-Centered Diabetes Care Through an Ethical Lens: Associations with Patient Satisfaction and Patient-Reported Outcomes in Saudi Primary Healthcare
TL;DR
Higher PCC was independently associated with better PREM, and female sex and severe self-rated health were associated with lower PROM scores, whereas older age and type 2 diabetes were associated with higher scores.
Abstract
Background: Patient-centered care (PCC) is central to diabetes management; unfortunately, evidence concerning its relationship with patient-reported outcome measures (PROM) in primary healthcare facilities in Jeddah is limited. This study examined the association between validated PCC scores and patient-reported outcomes and explored how PCC domains could be interpreted through four ethical principles. Methods: A cross-sectional survey was conducted on 594 adults with diabetes recruited from 47 primary care facilities between July and August 2023. The primary exposure was the validated 36-item, eight-domain PCC total score, while the primary outcome was a study-specific core PROM composite. Satisfaction and patient-reported experience measure (PREM) scores were measured as secondary measures. Statistical analysis was completed through multivariable ordinary least-squares regression with HC3 heteroscedasticity-robust standard errors adjusted for sociodemographic and health characteristics, while the four author-defined ethical groupings were examined exploratorily. Results: Among 594 adults with diabetes who completed the study, the mean PCC was 76.91 (SD 17.01), core PROM was 63.51 (SD 16.85), satisfaction was 81.41 (SD 19.30), and PREM was 77.27 (SD 20.45). PCC correlated with core PROM (r = 0.437), satisfaction (r = 0.251), and PREM (r = 0.239). In the primary adjusted model (n = 591), PCC remained positively associated with core PROM (B = 0.433, 95% CI [0.359, 0.507], p < 0.001). Female sex and severe self-rated health were associated with lower PROM scores, whereas older age and type 2 diabetes were associated with higher scores. The model explained 27.0% of PROM variance. Conclusions: Higher PCC was independently associated with better PREM. The ethical mapping provides a potentially useful interpretive framework but requires independent psychometric validation.