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LeBlanc ES, Rosales AG, Kachroo S, et al. Provider beliefs about diabetes treatment have little impact on glycemic control of their patients with diabetes. BMJ Open Diabetes Res Care. 2015;3(1):e000062doi: 10.1136/bmjdrc-2014-000062.
LeBlanc, E. S., Rosales, A. G., Kachroo, S., Mukherjee, J., Funk, K. L., Schneider, J. L., & Nichols, G. A. (2015). Provider beliefs about diabetes treatment have little impact on glycemic control of their patients with diabetes. BMJ open diabetes research & care, 3(1), e000062. https://doi.org/10.1136/bmjdrc-2014-000062
LeBlanc, Erin S, et al. "Provider beliefs about diabetes treatment have little impact on glycemic control of their patients with diabetes." BMJ open diabetes research & care vol. 3,1 (2015): e000062. doi: https://doi.org/10.1136/bmjdrc-2014-000062
LeBlanc ES, Rosales AG, Kachroo S, Mukherjee J, Funk KL, Schneider JL, Nichols GA. Provider beliefs about diabetes treatment have little impact on glycemic control of their patients with diabetes. BMJ Open Diabetes Res Care. 2015 Feb 24;3(1):e000062. doi: 10.1136/bmjdrc-2014-000062. eCollection 2015. PMID: 25741443; PMCID: PMC4342519.
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BMJ Open Diabetes Res Care. 2015 Feb 24;3(1):e000062. doi: 10.1136/bmjdrc-2014-000062. eCollection 2015.

Provider beliefs about diabetes treatment have little impact on glycemic control of their patients with diabetes.

BMJ open diabetes research & care

Erin S LeBlanc, A Gabriela Rosales, Sumesh Kachroo, Jayanti Mukherjee, Kristine L Funk, Jennifer L Schneider, Gregory A Nichols

Affiliations

  1. Kaiser Permanente Center for Health Research , Portland, Oregon , USA.
  2. Bristol-Myers Squibb , Wallingford, Connecticut , USA.

PMID: 25741443 PMCID: PMC4342519 DOI: 10.1136/bmjdrc-2014-000062

Abstract

OBJECTIVE: To improve the health of people with diabetes, it is essential to identify why patients experience extended periods of poor glycemic control before therapeutic intensification.

RESEARCH DESIGN AND METHODS: We surveyed 252 primary care providers at Kaiser Permanente Northwest to determine their beliefs about the glycemic goals of their patients, treatment intensification behavior, and barriers to achieving optimal glycemic control. We linked the responses of 149 providers to the health records of their 18 346 patients with diabetes.

RESULTS: Patient glycemic levels were not related to either individualized glycemic goals or provider intensification behavior. Providers' beliefs about diabetic treatment and glycated hemoglobin (HbA1c) goals were poorly associated with patient HbA1c levels. Providers identified patients' resistance to lifestyle behaviors and taking insulin, lack of medication adherence, and psychosocial issues as the main barriers to optimal glycemic control. Lack of time to care for complex patients was also a barrier. Providers who agreed that "current research did not support A1C levels <7%" were less likely to have patients with HbA1c levels <7% (OR=0.87, 95% CI 0.78 to 0.97) and patients of providers who disagreed that "some patients will have an A1C >9% no matter what I do" were 16% more likely to have patients with HbA1c <7% (1.16, 1.03 to 1.30) compared with providers who were neutral about those statements.

CONCLUSIONS: Given the consistency of HbA1c levels across providers despite differences in beliefs and intensification behaviors, these barriers may be best addressed by instituting changes at the system level (ie, instituting institutional glycemic targets or outreach for dysglycemia) rather than targeting practice patterns of individual providers.

Keywords: Health Services

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