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Research ArticleOriginal Research

Encounters by Patients With Type 2 Diabetes—Complex and Demanding: An Observational Study

Michael L. Parchman, Raquel L. Romero and Jacqueline A. Pugh
The Annals of Family Medicine January 2006, 4 (1) 40-45; DOI: https://doi.org/10.1370/afm.422
Michael L. Parchman
MD, MPH
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Raquel L. Romero
MD
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Jacqueline A. Pugh
MD
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    Figure 1.

    Time to next appointment and indicated services delivered.

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    Table 1.

    Characteristics of Observed Participants

    CharacteristicsNumber
    Age, y, mean (SD)59.1 (13.0)
    Male, %51.3
    Hispanic, %57.1
    Did not graduate from high school, %34.3
    No. of chronic diagnoses, mean (SD)4.8 (2.3)
    No. of chronic medications, mean (SD)6.4 (3.1)
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    Table 2.

    Content of Encounters

    ContentNumber
    Family member or significant other present, %34.1
    Length of visit, min, mean (SD)17.5 (8.8)
    No. of topics, questions, or symptoms, mean (SD)17.6 ( 7.6)
    No. of prescriptions provided, mean (SD)2.0 (1.8)
    Change in medication, %26.8
    Diet discussed, %70.1
    Diabetes education referral, %13.7
    Referral to other health care clinician, %31.8
    • View popup
    Table 3.

    Delivery of Indicated Services (N = 211 Encounters)

    Chronic Encounters (n = 161)Acute Encounters (n = 50)
    Diabetes ServiceIndicated No.Delivered No. (%)Indicated No.Delivered No. (%)
    HbA1c = gyclosylated hemoglobin. *If no previous diagnosis of nephropathy.
    HbA1c127118 (92.9)3626 (72.2)
    Lipid panel12796 (75.6)3626 (72.2)
    Urine microalbumin*12573 (58.4)3819 (50.5)
    Referral for dilated eye examination8237 (45.1)316 (19.3)
    Foot examination or podiatry referral14498 (68.1)4615 (32.6)

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  • The Article in Brief

    Encounters by patients with Type 2 diabetes are complex and demanding: an observational study

    Michael L. Parchman, MD, MPH , and colleagues

    Background During most patient visits, doctors have �competing demands,� that is, multiple health conditions and preventive measures that demand their attention. Because of limited time, doctors often prioritize those demands and deal only with the most urgent problems. This study looks at whether competing demands in the primary care doctor visit affect the delivery of medical care for diabetes.

    What This Study Found Needed diabetes services are less likely to occur during visits for the competing demand of acute illness. When fewer diabetes services are delivered, follow-up visits are scheduled sooner. More diabetes care is given when visits are longer.

    Implications

    • Competing demands during visits with patients who have type 2 diabetes can interfere with delivering needed diabetes services. In spite of this, primary care practices often make use of the acute illn
    • Changes in the primary care practice setting could improve the quality of diabetes care. New models of care are needed, such as group visits, as well as information technology that allows for manageme
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The Annals of Family Medicine: 4 (1)
The Annals of Family Medicine: 4 (1)
Vol. 4, Issue 1
1 Jan 2006
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Encounters by Patients With Type 2 Diabetes—Complex and Demanding: An Observational Study
Michael L. Parchman, Raquel L. Romero, Jacqueline A. Pugh
The Annals of Family Medicine Jan 2006, 4 (1) 40-45; DOI: 10.1370/afm.422

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Encounters by Patients With Type 2 Diabetes—Complex and Demanding: An Observational Study
Michael L. Parchman, Raquel L. Romero, Jacqueline A. Pugh
The Annals of Family Medicine Jan 2006, 4 (1) 40-45; DOI: 10.1370/afm.422
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