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When there is too much to do: how practicing physicians prioritize among recommended interventions
Timothy P Hofer1, Judith K Zemencuk, Rodney A Hayward
1Veterans Affairs Health Services Research and Development Center of Excellence, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA. thofer@umich.edu
Journal of General Internal Medicine
|June 24, 2004
Summary
Physician priorities in type 2 diabetes care often conflict with evidence. Recent beneficial treatments were underrated, while some performance measures were overrated, highlighting a need for better guideline dissemination.
Area of Science:
- Clinical Medicine
- Endocrinology
- Healthcare Management
Background:
- Physicians receive only 50% of recommended care processes.
- Understanding physician priorities in interventions is crucial.
- Priorities can be influenced intentionally and unintentionally.
Purpose of the Study:
- To assess physician priorities for 11 clinical triggers in type 2 diabetes management.
- To compare priorities between primary care physicians (PCPs) and endocrinologists.
- To evaluate the influence of guideline development efforts on physician priorities.
Main Methods:
- Survey mailed to 289 PCPs and 213 endocrinologists within the VA system.
- Response rate of 63% (n=315).
- Paired comparison method used to assess priorities for 11 clinical triggers.
Main Results:
- High-impact triggers (e.g., HbA1c=9.5%) were prioritized by both groups.
- Low-impact performance measures received high ratings.
- PCPs prioritized glycemic control over blood pressure control, contrary to evidence.
- Guideline intervention participation improved PCP blood pressure control ratings.
- Specialists' ratings were more aligned with epidemiological evidence.
Conclusions:
- Physician priorities in diabetes care show inconsistencies with current evidence.
- Recent high-benefit recommendations were underrated.
- Overrated performance measures and underrated new evidence necessitate improved guideline dissemination.
- Intervention priority, not just measurement ease, should guide guideline selection.