Primary care physicians' perceptions of diabetes management: A balancing act

Lynn D. Helseth, Jeffrey L. Susman, Benjamin F. Crabtree, Patrick J. O'Connor

Research output: Contribution to journalArticlepeer-review

43 Scopus citations

Abstract

BACKGROUND. Studies demonstrate significant shortfalls in the quality of care for diabetes. Primary care physicians' views of the management of diabetes have been inadequately explored. The Objective of our study was to describe primary care physicians' attitudes toward diabetes, patients with diabetes, and diabetes care. METHODS. In-depth interviews were conducted by a trained research interviewer with a sample of 10 family physicians and 9 internists in Connecticut. Interviews lasted an average of 60 minutes and were audiotaped and transcribed. Data were interpreted by a multidisciplinary team using a standard qualitative text analysis methodology. Themes from each interview were used to identify and develop overall themes related to the areas of inquiry. RESULTS. Physicians' goals were congruent with current guidelines emphasizing the importance of good glycemic control and prevention of complications. However, physicians noted the challenge of balancing the multiple goals of ideal diabetes care and the realities of patient adherence, expectations, and circumstances. The majority of physicians described a patient-centered management style, but a substantial minority described a more paternalistic approach. Physicians did not identify or describe office systems for facilitating diabetes management. Differences between family physicians and internists did not emerge. CONCLUSIONS. The complexity of diabetes care recommendations coupled with the need to tailor recommendations to individual patients produces wide variation in diabetes care. Improvement in care may depend on (1) prioritizing diabetes care recommendations for patients as individuals, (2) improving physicians' motivational counseling skills and enhancing their ability to deal with challenging patients, and (3) developing office systems and performance enhancement efforts that support cost-effective practice and patient adherence.

Original languageEnglish (US)
Pages (from-to)37-42
Number of pages6
JournalJournal of Family Practice
Volume48
Issue number1
StatePublished - Jan 1999
Externally publishedYes

All Science Journal Classification (ASJC) codes

  • Family Practice

Keywords

  • Attitude
  • Diabetes mellitus
  • Patient compliance
  • Research

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