Attitudes of Primary Care Providers Toward Diabetes: Barriers to guideline implementation
- Department of Orthodontics, University of Texas Health Science Center at San Antonio San Antonio, Texas
- Department of Medicine, University of Texas Health Science Center at San Antonio San Antonio, Texas
- Audie L. Murphy Memorial Veterans Hospital San Antonio, Texas
- Address correspondence and reprint requests to Anne C. Larme, PhD, Department of Orthodontics, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr., San Antonio, TX 78284-7910. E-mail: .
OBJECTIVE Primary care providers have been slow to adopt standards of care for diabetes, and continuing medical education (CME) programs have been minimally effective in changing provider behavior. The objective of this study was to explore the previously reported finding that attitudes, rather than knowledge, may impede primary care provider adherence to standards of care.
RESEARCH DESIGN AND METHODS Study participants included 31 primary care providers attending an eight-session CME program on diabetes. Providers rated on a 10-point scale how the treatment of diabetes compared with that of five other chronic conditions (hypertension, hyperlipidemia, angina, arthritis, and heart failure; 1 = easier to 10 = harder; midpoint 5.5). In a subsequent open-ended qualitative interview, providers explained their scale ratings.
RESULTS Diabetes was rated as significantly harder to treat than hypertension (24 of 30 >5.5; P < 0.001) and angina (20 of 30 >5.5; P = 0.03). A majority also rated hyperlipidemia (18 of 30) and arthritis (18 of 30) as easier to treat than diabetes. Explanatory themes underlying provider frustrations with diabetes include characteristics of the disease itself and the complexity of its management, and a perceived lack of support from society and the health care system for their efforts to control diabetes.
CONCLUSIONS CME that addresses provider attitudes toward diabetes in addition to updating knowledge may be more effective than traditional CME in promoting adherence to standards of care. Additional changes are needed in our health care system to shift from an acute to a chronic disease model to effectively support diabetes care efforts.
- Received November 20, 1997.
- Revision received April 29, 1998.
- Accepted April 29, 1998.
- Copyright © 1998 by the American Diabetes Association