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OBJECTIVE -Management of diabetes is frequently suboptimal in primary care settings, where providers often fail to intensify therapy when glucose levels are high, a problem known as clinical inertia. We asked whether interventions targeting clinical inertia can improve outcomes. RESEARCH DESIGN AND METHODS -A controlled trial over a 3-year period was conducted in a municipal hospital primary care clinic in a large academic medical center. We studied all patients (4,138) with type 2 diabetes who were seen in continuity clinics by 345 internal medicine residents and were randomized to be control subjects or to receive one of three interventions. Instead of consultative advice, the interventions were hard copy computerized reminders that provided patient-specific recommendations for management at the time of each patient's visit, individual face-to-face feedback on performance for 5 min every 2 weeks, or both.RESULTS -Over an average patient follow-up of 15 months within the intervention site, improvements in and final HbA 1c (A1C) with feedback ϩ reminders (⌬A1C 0.6%, final A1C 7.46%) were significantly better than control (⌬A1C 0.2%, final A1C 7.84%, P Ͻ 0.02); changes were smaller with feedback only and reminders only (P ϭ NS vs. control). Trends were similar but not significant with systolic blood pressure (sBP) and LDL cholesterol. Multivariable analysis showed that the feedback intervention independently facilitated attainment of American Diabetes Association goals for both A1C and sBP. Over a 2-year period, overall glycemic control improved in the intervention site but did not change in other primary care sites (final A1C 7.5 vs. 8.2%, P Ͻ 0.001).CONCLUSIONS -Feedback on performance aimed at overcoming clinical inertia and given to internal medicine resident primary care providers improves glycemic control. Partnering generalists with diabetes specialists may be important to enhance diabetes management in other primary care settings. Diabetes Care 28:2352-2360, 2005T ype 2 diabetes is a public health pandemic with devastating impact on morbidity, mortality, and cost. In the U.S., the prevalence of diabetes increased from 4.9% of the population in 1990 to 7.9% in 2001 (1-4), and prevalence is projected to rise to 30 million Americans in 2030 (5). The lifetime risk of diabetes is currently projected at 33 and 38% for American men and women, respectively, born in 2000 (6), with accompanying decrease in life expectancy (6 -8). Diabetes increases the risk of both microvascular (9,10) and macrovascular disease (11), and diabetes is now the sixth leading cause of death in the U.S (12). Diabetes accounted for ϳ11% of total U.S. health care expenditures in 2002 ($92 billion) (13), but better metabolic control can reduce costs (14).Most diabetes management in the U.S. takes place in primary care settings, where measures of both process and outcome indicate that care is often suboptimal. Surveys in the early 1990s revealed that many Medicare beneficiaries had limited evaluation of levels of HbA 1c (A1C), cholesterol, o...

The authors examined age differences in perceived coping resources and satisfaction with life across 3 older-adult age groups (45-64, 65-74, and 75 years and older). The 98 participants represented healthy, socially active, community-residing adults. Group comparisons were made on 12 individual coping scales, and an overall coping resource effectiveness score was computed. No significant differences were found for 11 of the coping resources or for overall coping resource effectiveness. Similar consistencies in life satisfaction were found across the 3 age groups. The findings indicate that (a) for healthy adults, the oldest old cope at least as effectively as their younger counterparts, despite their likelihood of encountering increased levels of stress; and (b) psychologically, old age may be viewed as a time of resilience and fortitude.

Global satisfaction with life across three age groups (18 to 40 years, 41 to 65 years, and 66 years and above) was investigated. Multiple regressions were computed to examine the separate and joint effects of perceived stress and coping resource availability upon life satisfaction across the three age groups (N = 189). Age differences in perceived stress, coping resource availability, and life satisfaction, were also investigated. Results of this cross-sectional investigation indicated that self-appraisal measures of perceived stress and coping resource effectiveness served as moderate predictors of global life satisfaction, and that for the total sample the combined effects of perceived stress and coping resource effectiveness were better predictors of life satisfaction than either variable considered separately. Perceived stress was found to be a better predictor of life satisfaction for younger adults, and coping resource effectiveness was a better predictor of satisfaction with life for middle-aged and older adults. Significant age differences in life satisfaction, perceived stress, and coping resources were also found. The assessment of perceived stress and coping has important implications for life satisfaction among all age groups, and has particular significance to older adults. By identifying age differences in variables associated with satisfaction with life, more effective efforts can be made to promote physical and psychological well-being in late adulthood.

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