PHYSICIAN AND PATIENT PREVENTION PRACTICES IN NIDDM IN A LARGE URBAN MANAGED-CARE ORGANIZATION

OBJECTIVE - To examine physician and patient adherence to prevention g uidelines in non-insulin-dependent diabetes mellitus (NIDDM) with atte ntion to possible differences in adherence by patient race or ethnicit y. RESEARCH DESIGN AND METHODS - We performed a cross-sectional chart review study of prevention practices, complications, and risk factors in 378 NIDDM patients (al least 5 years known duration) who were membe rs of the Kaiser Permanente Medical Care Program, Oakland, CA. There w ere 232 blacks, 81 whites, 29 Hispanics, and 36 members of other races /ethnicities. RESULTS - Age- and duration-adjusted prevalence of 14 co mplications was low and, with the exception of diabetic retinopathy, d id not differ significantly by race. An eight-point prevention score t hat reflected recommended use of glucose, HbA(1c), high-density lipopr otein/total cholesterol, blood pressure and proteinuria testing, ophth almology and foot examinations, and diabetes education during a 2-year period did not differ by race/ethnicity (P = 0.36). The mean score (4 .9 +/- 1.6) indicated that on average, five of eight guidelines were p erformed appropriately. Compliance was poorest for annual proteinuria checks (32.2%). No differences were noted by race/ethnicity in referra ls to ophthalmology, weight reduction, or smoking cessation or in miss ed appointments or failure to keep referral visits. CONCLUSIONS - The absence of racial differences in either prevention practices or compli cation rates in this insured prepaid setting suggests that improved ac cess to preventive services may be effective in reducing such differen ces nationally. However, adherence to several guidelines was less than or equal to 50%, indicating that physicians are not sufficiently conv inced of the necessity for these prevention measures.