Differential adoption of pharmacotherapy recommendations for type 2 diabetes by generalists and specialists

Newer, multimedication (novel) regimens provide better glycemic control for many type 2 diabetics when sulfonylurea monotherapy (traditional) becomes ineffective. Because better glycemic control is associated with decreased likelihood of complications and lower utilization and cost of care, the authors examined change in prescribing patterns for veterans with type 2 diabetes between FY 97 and 99. They classified medication regimens as traditional and novel based on the combination of diabetes medications patients received at the end of each year. Multivariate logistic regression analyses controlling for disease severity indicated that patients were more likely to receive novel regimens over time, but those seen only in primary care were less likely to receive novel regimens than those previously seen by a specialist. Geographic differences and differences in how recommendations were implemented by generalists and specialists suggest that diffusion of innovations theory may help explain variations in practice and guide interventions designed to translate research into practice.