Is diabetes treated as an acute or chronic illness in community family practice?

OBJECTIVE - Poor quality of diabetes care has been ascribed to the acute ca re focus of primary care practice. A better understanding of how time is sp ent during Outpatient visits for diabetes compared with visits for acute co nditions and other chronic diseases may facilitate the design of programs t o enhance diabetes care. RESEARCH DESIGN AND METHODS - Research nurses directly observed consecutive outpatient visits during two separate days in 138 community family physici an offices, Time use was categorized into 20 different behaviors using the Davis Observation Code (DOC). Time use was compared for visits for diabetes , other chronic conditions, and acute illnesses during 1,867 visits by pati ents greater than or equal to 40 years of age. RESULTS - of 20 DOC behavioral categories, 10 exhibited differences among t he three groups. Discriminant analysis identified two distinct factors that distinguished visits for chronic disease from visits for acute illness and visits for diabetes from those for other chronic diseases. Compared with v isits for other chronic diseases, visits for diabetes devoted a greater pro portion of time to nutrition counseling, health education, and feedback on results and less time to chatting. Compared with visits for acute illness, visits for diabetes were longer and involved a higher proportion of dietary advice, negotiation, and assessment of compliance. CONCLUSIONS - Visits for diabetes are distinct from visits for other chroni c diseases and acute illnesses in ways that may facilitate patient self-man agement. Novel quality-improvement interventions could support and expand e xisting differences between family physicians' current approaches to care o f diabetes and other chronic and acute illnesses.