August 2000 • Volume 6 • Number 8
1999 ACF survey results reflect complexity of diabetes care
BY CINDY McCANSE
Results are in from two member surveys on diabetes care, one mailed before and the other mailed after AAFP's 1999 Annual Clinical Focus, "Management and Prevention of the Complications of Diabetes." All in all, the results give voice to a common adage: The more you learn, the more you realize there is to know.
The two questionnaires, each mailed to 4,400 AAFP members, compared self-reported levels of skill and knowledge about several areas of diabetes care. Although most respondents reported improvement in both their knowledge about and performance of various components of diagnosis, evaluation and treatment of patients with diabetes, the results identified modest -- although not necessarily statistically significant -- declines in some areas, a not unexpected finding for what is, after all, an ongoing educational program.
Physicians' overall comfort level in managing diabetic patients markedly rose. Respondents said that their ability to identify risk factors for type 2 disease increased, as did their familiarity with the complex set of diagnostic criteria for diabetes. Improvement was also seen in the regularity with which they referred diabetic patients for ophthalmologic screening.
Management and Prevention of the Complications of Diabetes Questionnaire Results
Before ACF initiative
After ACF initiative
Physicians cited the following as areas in which they desired further education to expand their expertise and practice skills:
- identifying intervention strategies to ameliorate risk factors;
- choosing the latest approaches to treating patients with type 1 diabetes;
- helping patients become more compliant with their treatment regimens, including adherence to dietary and exercise recommendations;
- boosting the percentage of diabetic patients who receive annual foot examinations; and
- using a multidisciplinary health care team to manage patients with diabetes.
According to ACF medical director Stephen Spann, M.D., of Houston, the survey results reflect the complexity of diabetes care, especially care of patients with type 1 disease. "Family docs don't see many patients with type 1 diabetes, and it's not surprising that they desire more confidence in managing this condition," he said.
"Compliance is always a challenge, and everyone would like to know how to improve this, including the diabetologists," Spann said. "The desire to do better with foot exams is positive, as is the desire to better utilize a multidisciplinary team." These and other practice issues will be addressed through several follow-up intervention strategies, the first of which -- a Video CME program, "Evaluation and Management of Lower-Extremity Diabetic Ulcers" -- is scheduled for release in September.
Changes in practice that respondents said they would make as a result of their ACF training included learning more about the ever-increasing number of drugs available to treat patients with type 2 disease, focusing more closely on monitoring hemoglobin A1c levels to improve glycemic control and aggressively treating both micro- and macrovascular complications.
Additionally, staff of the AAFP National Network for Family Practice and Primary Care Research and Baylor College of Medicine in Houston have teamed up to conduct a year-long study to investigate patient, physician and practice characteristics associated with varying levels of glycemic control and other outcomes in patients with type 2 diabetes. Spann is the principal investigator for the study, which will lay the groundwork for future research to develop and test interventions to improve outcomes in diabetic patients in the primary care setting.
FP Report is published by the AAFP News Department.
Copyright © 2000 by American Academy of Family Physicians.
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