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Is Diabetes Treated as an Acute or Chronic Illness in Community Family Practice?

¹ Department of Research, Olmsted Medical Center, Rochester, Minnesota; the Departments of
² Family Medicine
³ Epidemiology and Biostatistics, and
⁴ Sociology, Case Western Reserve University
⁵ Ireland Comprehensive Cancer Center, University Hospitals of Cleveland
⁶ Center for Research in Family Practice and Primary Care, Cleveland, Ohio

OBJECTIVE—Poor quality of diabetes care has been ascribed to the acute care focus of primary care practice. A better understanding of how time is spent during outpatient visits for diabetes compared with visits for acute conditions and other chronic diseases may facilitate the design of programs to enhance diabetes care.

RESEARCH DESIGN AND METHODS—Research nurses directly observed consecutive outpatient visits during two separate days in 138 community family physician offices. Time use was categorized into 20 different behaviors using the Davis Observation Code (DOC). Time use was compared for visits for diabetes, other chronic conditions, and acute illnesses during 1,867 visits by patients 40 years of age.

RESULTS—Of 20 DOC behavioral categories, 10 exhibited differences among the three groups. Discriminant analysis identified two distinct factors that distinguished visits for chronic disease from visits for acute illness and visits for diabetes from those for other chronic diseases. Compared with visits for other chronic diseases, visits for diabetes devoted a greater proportion of time to nutrition counseling, health education, and feedback on results and less time to chatting. Compared with visits for acute illness, visits for diabetes were longer and involved a higher proportion of dietary advice, negotiation, and assessment of compliance.

CONCLUSIONS—Visits for diabetes are distinct from visits for other chronic diseases and acute illnesses in ways that may facilitate patient self-management. Novel quality-improvement interventions could support and expand existing differences between family physicians’ current approaches to care of diabetes and other chronic and acute illnesses.

Abbreviations: DOC, Davis Observation Code • DOPC, Direct Observation of Primary Care

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