Impact of a program to improve adherence to diabetes guidelines by primary care physicians

M. Sue Kirkman, Susanna R. Williams, Helena H. Caffrey, David Marrero

Research output: Contribution to journalArticle

146 Citations (Scopus)

Abstract

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 HbA1c 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 = 0.002), foot exams (19 vs. 42%; P < 0.001), HbA1c measurements (26 vs. 37%; P = 0.012), and PCP eye exams (38 vs. 46%; P = 0.043); a trend toward improvement was seen in referral to eye specialists (25 vs. 33%; P = 0.059). After a second year of multiple interventions, only blood pressure measurements (70 vs. 92%; P < 0.001) and foot exams (22 vs. 47%; P < 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.

Original languageEnglish
Pages (from-to)1946-1951
Number of pages6
JournalDiabetes Care
Volume25
Issue number11
DOIs
StatePublished - Nov 2002

Fingerprint

Primary Care Physicians
Guidelines
Foot
Blood Pressure
Consensus
Referral and Consultation
Physicians
Guideline Adherence
Patient Education
Meals
Primary Health Care
Patient Care
Research Design
Urine
Delivery of Health Care
Lipids
Glucose
Proteins

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism

Cite this

Impact of a program to improve adherence to diabetes guidelines by primary care physicians. / Kirkman, M. Sue; Williams, Susanna R.; Caffrey, Helena H.; Marrero, David.

In: Diabetes Care, Vol. 25, No. 11, 11.2002, p. 1946-1951.

Research output: Contribution to journalArticle

Kirkman, M. Sue ; Williams, Susanna R. ; Caffrey, Helena H. ; Marrero, David. / Impact of a program to improve adherence to diabetes guidelines by primary care physicians. In: Diabetes Care. 2002 ; Vol. 25, No. 11. pp. 1946-1951.
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abstract = "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 HbA1c 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 = 0.002), foot exams (19 vs. 42{\%}; P < 0.001), HbA1c measurements (26 vs. 37{\%}; P = 0.012), and PCP eye exams (38 vs. 46{\%}; P = 0.043); a trend toward improvement was seen in referral to eye specialists (25 vs. 33{\%}; P = 0.059). After a second year of multiple interventions, only blood pressure measurements (70 vs. 92{\%}; P < 0.001) and foot exams (22 vs. 47{\%}; P < 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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AB - 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 HbA1c 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 = 0.002), foot exams (19 vs. 42%; P < 0.001), HbA1c measurements (26 vs. 37%; P = 0.012), and PCP eye exams (38 vs. 46%; P = 0.043); a trend toward improvement was seen in referral to eye specialists (25 vs. 33%; P = 0.059). After a second year of multiple interventions, only blood pressure measurements (70 vs. 92%; P < 0.001) and foot exams (22 vs. 47%; P < 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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