PATIENT AND PHYSICIAN PERSPECTIVES REGARDING TREATMENT OF DIABETES - COMPLIANCE WITH PRACTICE GUIDELINES

BACKGROUND. Managed care organizations are focusing on how physicians manage their patients with diabetes mellitus as an indicator of physic ian compliance with clinical practice guidelines. Assessment of physic ian compliance with published guidelines may reveal areas of disagreem ent between physicians and guidelines or between physicians and patien ts and may show areas for potential improvement of care. Compliance wi th the diabetes care guidelines was assessed in our clinics to determi ne physician beliefs and performance and patients' accommodation of re commended practices. METHODS. We interviewed 295 patients with diabete s and surveyed 47 providers at an academic family practice center to a ssess practices and beliefs regarding the care of patients with diabet es. We also reviewed a 1-year compilation of billing and referral reco rds for physician use of glycosylated hemoglobin (hemoglobin A(1c)) te sting and referral of patients for eye examinations. RESULTS. We found that physician beliefs and practices were divergent and that provider performance of these nationally recommended activities was low. More than 75% of providers said that they recommended hemoglobin Ale testin g, but only about 50% of patients had a documented test in the billing system. When questioned, one third of the patients reported that thei r physicians recommended this test. Similarly, nearly all physicians s tated that they recommended annual eye examinations, although only 43% of patients said that their primary care physician recommended this r eferral. CONCLUSIONS. Physicians can and must improve intervention and patient education in the care of diabetic patients. Patient knowledge , motivation, and practice must be augmented by physician efforts. Lac k of compliance with guidelines may indicate deficiencies in physician knowledge, implementation problems, lack of belief in guidelines, or problems in patient compliance. Attention should be directed to all th ese areas.