Variation in Diabetes Management: A National Assessment of Primary Care Providers
| Autor: | Enrico de Belen, Mary Tran, Jeffrey R. Dahlen, Maria Czarina Acelajado, John W. Peabody, David Paculdo |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
Blood Glucose
medicine.medical_specialty Glucose control Endocrinology Diabetes and Metabolism education Biomedical Engineering 030209 endocrinology & metabolism Bioengineering Primary care Glycemic Control 03 medical and health sciences Hba1c level 0302 clinical medicine Diabetes management Diabetes mellitus Internal Medicine medicine Diabetes Mellitus Humans In patient 030212 general & internal medicine Glycemic Quality of Health Care Glycated Hemoglobin Evidence-Based Medicine Primary Health Care business.industry Disease Management Original Articles medicine.disease United States Variation (linguistics) Health Care Surveys Emergency medicine business |
| Zdroj: | J Diabetes Sci Technol |
| ISSN: | 1932-2968 |
| Popis: | Background:Glucose control is monitored primarily through ordering HbA1c levels, which is problematic in patients with glycemic variability. Herein, we report on the management of these patients by board-certified primary care providers (PCPs) in the United States.Methods:We measured provider practice in a representative sample of 156 PCPs. All providers cared for simulated patients with diabetes presenting with symptoms of glycemic variability. Provider responses were reviewed by trained clinicians against evidence-based care standards and accepted standard of care protocols.Results:Care varied widely—overall quality of care averaged 51.3%±10.6%—with providers performing just over half the evidence-based practices necessary for their cases. More worryingly, provider identified the underlying etiology of the poor glycemic control only 36.3% of the time. HbA1c was routinely ordered in 91.3% of all cases but often (59.5%) inappropriately. Ordering other tests of glycemic control (done in 15% of cases) led to significant increases in identifying the etiology of the hyperglycemia. Correctly modifying their patient’s treatment was more likely to occur if doctors first identified the underlying etiology (65.9% vs 49.0%, PConclusion:Despite established evidence that HbA1c misses short-term changes in diabetes, we found PCPs consistently ordered HbA1c, rarely using other available blood tests. However, if the factors leading to poor glycemic control were recognized, PCPs were more likely to correctly alter their patient’s hypoglycemic therapy. |
| Databáze: | OpenAIRE |
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