Table Box 7.
Patient 4: ‘Poor–Poor’
| Case history |
| A 53‐year‐old, married man who on entry to the study had had diabetes for 13 years (I hadn’t taken it seriously at all.) He did not know what to expect from PACCTS. Obviously I thought it might be of some benefit to myself to, you know, a greater understanding of diabetes. |
| Perspective at baseline |
| The calls have made me more aware of what I need to do to keep control and also it has made me more aware of the implications in the future. He has learned even things like food intake, what to eat, what not to eat. He does not let diabetes interfere too much with lifestyle. The blood monitoring has made a difference: it does help give me more interest in myself to see whether I’m doing well so now I’m doing like four a day now. And, I want to do it for XXX (the tele‐carer). Doing the blood sugar levels checks is not a pressure as such I see it as I want to do it and at least feel that I’m doing what I should be. |
| Perspective at 2‐year follow‐up |
| He expresses awareness about his level of control: my control hasn’t been desperately exciting. While at the beginning of the study, it was up and down, not regular at all. However, this is now more under control since I started the study…. I find it difficult …but I think I do quite well really. He knows more about diabetes now: I am more aware in a way that is helpful rather than in a way that makes you frightened to do things. The most positive aspect has been definitely awareness and education. PACCTS has also had an impact on his wider family. I didn’t even tell anybody that I was diabetic apart from my wife and close family because I thought it would go away – which of course, it won’t. …. Well, the wife eats what I eat and the kids are aware of the implications of diabetes… Reflecting on his initial expectations, he comments: I felt that they were trying to help me and I was doing nothing to help myself to help them. So that is why I then started to take it more seriously. I had, shall we say, more respect for the readings and I started trying to do what they were asking me to do. |
| Changes |
| He has changed his diet; it still comes as a surprise when someone asks if you are eating wholemeal bread. The advice has helped him in relation to just even small things (what to do if his reading is too low or too high) and to feel more motivated now to keep his diet under control (it just makes me feel that I just have to get it back under control). He started to take his diabetes more seriously, more or less when these calls started…. you still sort of tend to rely on the medication but somebody explained that you need to control it yourself if you can and let the medication do the rest rather than the other way round. He expresses greater control and a sense of empowerment; I contribute to the care myself rather than feeling that I am on the edge of it. |
| Sustainability |
| He is not confident about his ability to control his diabetes if the calls were to cease: I would, but for how long? |
| The relationship |
| They know me…. It is more of a discussion with two parties rather than being told, ‘You need to do this and that and then come back and see me in 6 months.’ |