Diabetes Care for Medicare Beneficiaries: Attitudes and behaviors of primary care physicians

  1. Barbara Fleming, MD, PHD
  1. Center for Clinical Measurement and Improvement, Health Standards and Quality Bureau, Health Care Financing Administration Baltimore
  2. Office of Managed Care, Health Standards and Quality Bureau, Health Care Financing Administration Baltimore
  3. Delmarva Foundation for Medical Care Easton, Maryland
  4. Alabama Quality Assurance Foundation Birmingham, Alabama
  5. Blue Cross and Blue Shield of Florida Jacksonville, Florida
  1. Address correspondence and reprint requests to Jan Drass, RN, MA, CDE, Health Care Financing Administration, 7500 Security Blvd., Room Sl-16–15, Baltimore, MD 21244–1850.


OBJECTIVE To obtain information related to primary care physician (PCP) attitudes, knowledge, and practice patterns, as well as perceptions about barriers to care and the use of materials to assist in the delivery of diabetes care for elderly patients in the office setting.

RESEARCH DESIGN AND METHODS A survey was mailed to a random sample (n = 900) of PCPs (internal medicine, family practice, and general practice physicians and endocrinologists) from the states of Alabama, Iowa, and Maryland who met selection criteria and provided diabetes care to ≥25 Medicare beneficiaries during calendar year 1993.

RESULTS Respondents provided self-reported information regarding diabetes care for elderly patients. PCP respondents (n = 370) considered blood glucose control to be the most important treatment goal. Most respondents (92%) considered acceptable GHb values to be those < 8%. Blood pressure measurement and foot inspections for the detection of ulcers and infection were the most commonly reported routine procedures performed as part of an office visit. Laboratory tests reported to be frequently ordered included GHb, serum creatinine, and proteinuria tests. Patient nonadherence to the treatment regimen was reported to be the most common barrier to care. The majority of respondents reported using two treatment aids in caring for patients with diabetes.

CONCLUSIONS The results of this study provide some evidence that PCP self-reported attitudes, knowledge, and practice patterns in delivering diabetes care for elderly patients in the office setting more closely reflect current recommended practice than reported in previous physician surveys. Opportunities for improvement still exist.

  • Received October 13, 1997.
  • Accepted May 5, 1998.
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