Disease management for diabetes among family physicians and general internists: Opportunism or planned care?

Background and Objectives: Diabetes requires substantial ongoing medical ma nagement and use of monitoring tests. However physicians' performance of th ese tests is often suboptimal. This study, explored primary care physicians ' management of diabetes in the context of both planned diabetes visits and acute visits for conditions unrelated to diabetes. Methods: Semi-structure d depth interviews were conducted with 12 primary care physicians in 9 fami ly practice and internal medicine practices distributed throughout the stat e of South Carolina. All interviews were tape recorded and transcribed. The mes, divergences, and trends were identified and discussed by the investiga tors. Results: Although all participants reported a preference toward plann ed diabetes management, because most patients fail to adhere to scheduled c are, opportunistic disease management tended to be the default mode of diab etes care. Participants reported performing appropriate tests during schedu led visits but acknowledged that when confined to acute visits, diabetes ca re was difficult to perform. Reasons included time constraints and patient agenda. Participants reported that inadequate tracking of completion of dia betes standards of care influenced their adherence to guidelines. Conclusio ns: The current system of delivering diabetes care opportunistically in the context of non-diabetes acute visits may need to be more closely examined in an effort to improve the delivery of services.