Patient-Centered Guidelines for Geriatric Diabetes Care: Potential Missed Opportunities to Avoid Harm

Journal of the American Board of Family Medicine: JABFM

Robert L. Kane^1¹  Sarah E. Gollust^1²  Ellen M. McCreedy^1³ 

[1] University of Minnesota School of Public Health, Minneapolis (RLK);and the Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis (KDC)^1;From the Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis (EMM, SEG, NDS)

关键词: Blood Glucose;    Clinical Decision-Making;    Diabetes Mellitus;    Geriatric Health Services;    Hyperglycemia;    Hypoglycemic Agents;    Patient-Centered Care;    Primary Health Care;   

DOI  :  10.3122/jabfm.2018.02.170141

学科分类：过敏症与临床免疫学

来源: The American Board of Family Medicine

【 摘 要 】

Background: Clinicians strive to deliver individualized, patient-centered care. However, these intentions are understudied. This research explores how patient characteristics associated with an high risk-to-benefit ratio with hypoglycemia medications affect decision making by primary care clinicians. Methods: Using a vignette-based survey, we queried primary care clinicians on their intended management of geriatric patients with diabetes. The patients' ages, disease durations, and comorbidities were systematically varied. Clinicians indicated whether they would intensify glycemic control by adding a second-line hypoglycemia medication. Results: A convenience sample of 336 primary care clinicians completed the survey. Despite the recommendations for HbA_1c targets 1c of 7.5%, longstanding diabetes, coronary disease, and cognitive impairment and with instrumental activity of daily living dependencies, had a predicted probability of treatment intensification of 35%. Internists were 11% and nurse practitioners were 14% more likely to intensify treatment than family physicians ( P < .01). These provider differences remained significant after controlling for geographic differences in treatment intensification. Providers in Florida were more likely to intensify treatment ( P < .01). Conclusions: Primary care clinicians often chose to intensify glycemic control despite individual patient factors that warrant higher glycemic targets based on existing guidelines. This research identifies possible missed opportunities for patient-centered goal setting and raises questions about the influence of training and practice environment on clinical decision making.

【 授权许可】

CC BY