Internal Medicine Resident Adherence to Evidence-Based Practices in Management of Diabetes Mellitus

Abstract

Objective Diabetic preventative health maintenance involves (1) adherence to guidelines and (2) appropriate documentation. This study evaluates the frequency with which internal medicine (IM) residents met these two outcomes. We also evaluated if there were differences in outcomes between resident classes. Methods In this retrospective analysis, 234 diabetic outpatient visits were analyzed. Guidelines were derived from the American Diabetes Association (ADA). The outcomes for each guideline were averaged and stratified by resident class. Averages within and between classes were compared using the student's paired t-test and one-way ANOVA respectively. Results Classes were most adherent to A1c testing guidelines (PGY-1 96.1%, PGY-2 97.6%, and PGY-3 95.9%). PGY-1 and PGY-2 classes were least adherent to podiatry (27.5% and 17.6% respectively), whereas PGY-3 had equal least adherence rates to podiatry and lifestyle modification guidelines (36.7%). All classes had highest rates in documenting A1c findings (PGY-1 92.2%, PGY-2 97.6%, and PGY-3 85.7%) and lowest rates in documenting relevant podiatry information (PGY-1 5.9%, PGY-2 5.9%, and PGY-3 11.2%). Comparing sequential resident classes, there was a decline in lifestyle counselling and documentation from PGY-1 to PGY-2. From PGY-2 to PGY-3, there was improvement in adherence to statin, podiatry, microalbuminuria, and monofilament guidelines. There was also improvement in documenting statin and monofilament usage, however, A1c reporting declined. Conclusion The findings of the study suggest disproportionate levels of care in diabetes preventative management. Additionally, program directors should take caution in assuming linear improvement with sequential resident classes.

Effects of Practice Ownership and Integration of Health Services on Adherence to Diabetes Guidelines

“…Our data also showed that regardless of ownership, laboratory tests such as hemoglobin A1C and serum creatinine were offered more frequently than others, such as foot exams, similar to what was found in previous studies. 7 , 8 This could be due to the relative ease of completing said services. Ordering a lab test may seem to be simpler than completing a comprehensive foot examination, and in a setting where time constraints are frequent, the latter could be ignored.…”

“…Unfortunately, physician adherence to these guidelines is poor, 5 , 6 with certain services, such as hemoglobin A1C testing, offered more frequently than others, such as foot exams. 7 , 8 …”