Survey of Physician Practice Behaviors Related to Diabetes Mellitus in the U.S.: Physician adherence to consensus recommendations

Kenny, Susan J; Smith, Philip J.; Goldschmid, Merilyn G.; Newman, Jeffrey; Herman, William H.

doi:10.2337/diacare.16.11.1507

Cited by 98 publications

(52 citation statements)

References 5 publications

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“…CONCLUSIONS -Our finding of low levels of adherence by PCPs to a broad array of diabetes guidelines is consistent with findings by other researchers (2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17). Prior studies have demonstrated successful interventions to improve adherence to diabetes guidelines by PCPs.…”

Section: Analysessupporting

confidence: 80%

Impact of a Program to Improve Adherence to Diabetes Guidelines by Primary Care Physicians

et al. 2002

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OBJECTIVES -Previous studies have shown that primary care physician (PCP) adherence to diabetes guidelines is suboptimal. We sought to determine the state of diabetes care given by independently practicing PCPs in a rural county in Indiana and whether a multifaceted intervention targeting PCPs, patients, and the health care system would improve adherence to diabetes guidelines.RESEARCH DESIGN AND METHODS -Baseline audits to assess adherence to diabetes guidelines were done on charts of the seven PCPs in the county. Audits were repeated after development of local consensus guidelines and feedback of baseline performance and after implementation of various interventions (practice aids, physician detailing, patient education sessions, and implementation of computerized individual meal planning).RESULTS -Before any intervention, rates of adherence to guidelines were low (15% for foot exams, 20% for HbA 1c measurement, 23% for eye exam referrals, 33% for urine protein screening, 44% for lipid profiles, 73% for home glucose monitoring, and 78% for blood pressure measurements). One year after development of local consensus guidelines and feedback of baseline performance, significant improvements were seen in blood pressure measurements (71 vs. 83%; P ϭ 0.002), foot exams (19 vs. 42%; P Ͻ 0.001), HbA 1c measurements (26 vs. 37%; P ϭ 0.012), and PCP eye exams (38 vs. 46%; P ϭ 0.043); a trend toward improvement was seen in referral to eye specialists (25 vs. 33%; P ϭ 0.059). After a second year of multiple interventions, only blood pressure measurements (70 vs. 92%; P Ͻ 0.001) and foot exams (22 vs. 47%; P Ͻ 0.001) remained significantly improved; all other areas returned to rates indistinguishable from baseline.CONCLUSIONS -In busy primary care practices lacking organizational support and computerized tracking systems, sustained improvements in diabetes care are difficult to attain using traditional physician-targeted approaches.

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Section: Analysessupporting

confidence: 80%

Impact of a Program to Improve Adherence to Diabetes Guidelines by Primary Care Physicians

et al. 2002

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“…La evaluación de la calidad de la atención se ha realizado a partir de estadísticas vitales, registros médicos de los pacientes, informes de los profesionales de la salud y encuestas a los pacientes (11,12).…”

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Evaluation of the quality of care for diabetic patients in Latin America

Gagliardino¹,

Hera²,

Siri³

2001

Rev Panam Salud Publica

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“…While patient assessment is critical, we need to focus on provider behavior, a fundamental component of quality of care evaluations for other medical therapies. 4,5 Consensus guidelines 6,7 provide a roadmap for operationalizing appropriate prescribing; herein we highlight concepts that deserve special emphasis and serve as the basis for recommendations described below. At the core of appropriate ongoing opioid prescribing, and all medical therapies, is timely, effective monitoring for, and response to, evident harms and benefits of therapy, including discontinuation of therapy when harms outweigh benefit or benefit is lacking.…”

Section: Characterizing Appropriate Ongoing Opioid Prescribing: Shiftmentioning

confidence: 99%

A Research Agenda for Enhancing Appropriate Opioid Prescribing in Primary Care

et al. 2013

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The challenges facing patients and providers in managing ongoing opioid analgesic therapy for chronic pain are complex. Benefit of long-term opioid therapy, for which there are scant data, must be balanced against myriad potential undesired outcomes, including safety problems, ranging from mild toxicities to overdose and death; inadequate efficacy, which may mean continued patient suffering and unwarranted exposure to toxicities; and misuse of these potent medications. To help patients and providers navigate these challenges and optimize therapy, we present a research agenda in which we first characterize appropriate ongoing opioid prescribing and then describe three areas where quality improvement work is needed: 1) developing brief validated measures of patient-reported safety, efficacy, and misuse that improve outcomes; 2) designing evidence-based algorithms to guide changes in therapy when issues related to safety, efficacy or misuse are identified; and 3) promoting use of patientcentered, multi-modal treatment plans.KEY WORDS: opioid analgesics; medication safety; provider behavior; quality of care.

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Survey of Physician Practice Behaviors Related to Diabetes Mellitus in the U.S.: Physician adherence to consensus recommendations

Abstract: Recommendations for the care of diabetic individuals need to be more widely implemented. Recommendations targeted specifically to pediatricians may be necessary.

Cited by 98 publications

References 5 publications

Impact of a Program to Improve Adherence to Diabetes Guidelines by Primary Care Physicians

Impact of a Program to Improve Adherence to Diabetes Guidelines by Primary Care Physicians

Evaluation of the quality of care for diabetic patients in Latin America

A Research Agenda for Enhancing Appropriate Opioid Prescribing in Primary Care

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