Abstract
The purpose of this study was to examine practice patterns of rural family physicians in the care of non-insulin-dependent diabetes mellitus based on the standards of care of the American Diabetes Association (ADA). One hundred patient charts were randomly chosen, twenty for each physician, from the practices of five family physicians in rural Ohio. A standardized collection protocol was used, based upon the ADA recommendations. The charts were reviewed for compliance with the ADA parameters. The patients' records demonstrated 66% compliance with dietary counseling and 33% with counseling about exercise. Moreover, there was low compliance with physical examination guidelines. Specifically, 66% of the patients had fundoscopic examination and 64% had a complete foot examination done. With respect to the laboratory guidelines, 70% of the charts reviewed had a urinalysis ordered and 45% annual lipids measured. However, glycosylated hemoglobin was performed in only 15% of the patients. The results suggest that rural family physicians do not consistently follow the ADA standards of care.
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Harris MI, Hadden WC, Knowler WC, Bennet PH. Prevalence of Diabetes and impaired glucose tolerance and plasma glucose levels in U.S. population aged 20–74 years. Diabetes 1987, 36: 5223–534.
American Diabetes Association. Screening for diabetes. Diabetes Care 1992; 15 supplement 2: 7–9.
Reenders K, DeNobel E, Vanden-Hoogen HJ, Rutten GE, Van Weel C. Diabetes and its long term complications in general practice: a survey in a well defined population. Fam Pract 1993; 10: 169–72.
Harris MI. Epidemiology of diabetes mellitus among the elderly in the United States. Clin Ger Med. 1990; 6:703–19.
Cook J, Daneman D, Spino M, Sochett E, Periman K, Balfe W. Angiotensin converting enzyme inhibitor therapy to decrease microalbuminuria in normotensive children with insulin-dependent diabetes mellitus. J Pediatrics 1990; 117: 39–45.
Lauritzen T, Frost W, Larsen HW, Deckert T, Christiansen JS, Parving HH, Binder C, Nerup J. Effects of 6 months of strict metabolic control on eye and kidney function in insulin-dependent diabetes with background retinopathy. Lancet 1982; 1:121–123.
DCCT Research Group. The effect of an intensive treatment of diabetes on the development and progression of long term complications in insulin-dependent diabetes mellitus. N Eng J Med 1993; 329:977–86.
American Diabetes Association. Standards of medical care for patients with diabetes mellitus. Diabetes Care 1989; 12:365–368.
Institute of Medicine, Committee on Clinical Practice Guidelines. Guidelines for Clinical Practice: From Development to Use. Fields MJ, Lahr KN, (eds). Washington DC: National Academy Press, 1992.
Mcgill MJ, Yue DK, Plewhwe WE, Willey, KA, Turtle JR. Single visit screening of diabetic complications. Diabetes Care; 12:599–600.
Thorn PA, Watkins PJ. Organization of diabetic care. BMJ; 285:787–789.
Spraska JM, Fritsche TL, Baker R, Rurth D, Whipple D. The prevalence of undiagnosed eye disease in high risk diabetic individuals. Arch Intern Med 1990; 150:857–61.
Fain JA, Melkus GD. Nurse practitioner practice patterns based on standards of medical care for patients with diabetes. Diabetes Care 1994; 17:879–881.
Jacques CHM, Jones RL, Houts P, Bauer LC, Dwyer KM, Lynch JC, Casale TS. Reported practice behaviors for medical care of patients with diabetes mellitus by primary care physicians in Pennsylvania. Diabetes Care 1991; 14:712–17.
Kenny SJ, Smith PJ, Goldschmid MG, Newman JM, Herman WH. Survey of physician practice behavior related to diabetes mellitus in the U.S. Diabetes Care 1993; 16:1507–10.
Reiber GE. Diabetic foot care: financial implications and practice guidelines. Diabetes Care 1992; (15) suppl. 1:29–31.
Schapira DV, Lyman GH, Kumar NB, Baile WF. The effects of duration of intervention and focus of control on dietary change. Am J of Prev Med 1991; 7:341–7.
Report of the US Preventive Services Task Force. Guide to clinical prevention services: an assessment of the effectiveness of 169 interventions. Williams and Wilkins, 1989.
Gall M, Rossing P, Skott P, Bamsbo P, Vaag A, Bech K et al. Prevalence of micro and macro albuminuria, arterial hypertension, retinopathy and large vessel disease in European type 2 (noninsulin dependent) diabetic patients. Diabetologia 1991; 34:655–61.
Kerr CP. Improving outcome in Diabetes: a review of the outpatient care of NIDDM patients. Journal of Family Practice 1995; 40:63–75.
Gibbins RL, Rowland CJ, Saunders J. A management system for diabetes in general practice. Diabetic Med 1986; 3:477–79.
Hoppener P, Knottnerus JA, Grol R, Metsemakers JF. Computerization of general practices and quality control. Blood glucose regulation in type 2 diabetics investigated in the registration network family practices. Fam Pract 1992; 9:353–6.
Rethans JJ, Martin E Metsmakers J. To what extent do clinical notes by general practitioners reflect the actual medical performance? A study using simulated patients. Br J Gen Pract 1994; 44: 153–6.
Grol R, Thomas S, Roberts R. Development and implementation of guidelines for family practice: Lessons from the Netherlands. J Fam Pract 1995; 40: 435–9.
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Zoorob, R.J., Mainous, A.G. Practice patterns of rural family physicians based on the American Diabetes Association standards of care. J Community Health 21, 175–182 (1996). https://doi.org/10.1007/BF01557997
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DOI: https://doi.org/10.1007/BF01557997