HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Hicks, P. C. Articles by Parnes, B. Search for Related Content PubMed PubMed Citation Articles by Hicks, P. C. Articles by Parnes, B. Social Bookmarking                What's this?

Action or Inaction? Decision Making in Patients With Diabetes and Elevated Blood Pressure in Primary Care

¹ Salud Family Health Center, Fort Lupton, Colorado
² Department of Family Medicine, University of Colorado Health Sciences Center at Fitzsimons, Aurora, Colorado
³ Foundation for Healthy Living, Latham, New York

Address correspondence and reprint requests to Paul C. Hicks, MD, Salud Family Health Center, 1115 Second St., Fort Lupton, CO 80621. E-mail: phicks{at}saludclinic.org

OBJECTIVE—Hypertension increases micro- and macrovascular complications of diabetes. The goal for blood pressure is <130/80 mmHg. In primary care, however, blood pressure in many patients exceeds this goal. In this study, we evaluated the clinical decision-making process when a patient with diabetes presents with elevated blood pressure.

RESEARCH DESIGN AND METHODS—Twenty-six primary care practices in two practice-based research networks in Colorado participated. Questionnaires were completed after each encounter with an adult with type 2 diabetes. Data obtained from the survey included 1) demographic information, 2) blood pressure results, 3) action taken, 4) type of action if action was taken, and 5) reasons for inaction if action was not taken. Bivariate and multivariate analyses were performed to identify predictors of action.

RESULTS—Completed surveys totaled 778. Blood pressure was 130/74 ± 18.8/12.0 mmHg (mean ± SD). Sixty-two percent of patients exceeded goals. Action was taken to lower blood pressure in 34.9% of those. Predictors of action were 1) blood pressure level, 2) total number of medicines the patient was taking, and 3) patient already taking medicines for blood pressure. As blood pressure rose, providers attributed inaction more often to "competing demands" and reasons other than "blood pressure being at or near goal."

CONCLUSIONS—No evidence was found for patterns of poor care among primary care physicians. Providers balance the clinical circumstances, including how elevated the blood pressure is, and issues of polypharmacy, medication side effects, and costs when determining the best course of action. Knowledge deficit is not a common cause of inaction.

CiteULike    Del.icio.us    Digg    Reddit    Technorati    What's this?

This article has been cited by other articles:

				K. Fiscella and R. M. Epstein So Much to Do, So Little Time: Care for the Socially Disadvantaged and the 15-Minute Visit Arch Intern Med, September 22, 2008; 168(17): 1843 - 1852. [Abstract] [Full Text] [PDF]

				E. A. Kerr, B. J. Zikmund-Fisher, M. L. Klamerus, U. Subramanian, M. M. Hogan, and T. P. Hofer The Role of Clinical Uncertainty in Treatment Decisions for Diabetic Patients with Uncontrolled Blood Pressure Ann Intern Med, May 20, 2008; 148(10): 717 - 727. [Abstract] [Full Text] [PDF]

				J. Voorham, F. M. Haaijer-Ruskamp, R. P. Stolk, B. H.R. Wolffenbuttel, P. Denig, and the Groningen Initiative to Analyze Type 2 Diabete Influence of Elevated Cardiometabolic Risk Factor Levels on Treatment Changes in Type 2 Diabetes Diabetes Care, March 1, 2008; 31(3): 501 - 503. [Abstract] [Full Text] [PDF]