As the title indicates, this article is devoted to improving physician based compliance with evidence-based guidelines. To get more specific, the primary objective of this paper was to examine why physicians don't follow known "best practices" when treating patients with type 2 diabetes.
Method
The research design for this study was a descriptive study based upon self-assessed compliance. The research team consisted of 85 internists who volunteered to aid in conducting the study. The physicians were queried by the internists sending out 7,000 randomly generated survey requests (using a professional organization) and 800 of the 7,000 expressed interest and 137 went on to complete the task. In completing the survey, the physicians simply reviewed their own charts for type 2 diabetes patients and then reported open-ended comments for the reasons they did not comply with known "best practices".
Results/Conclusion
For diabetes care measures, the "physician noncompliance was most common for screening urinalysis(26%) and screening microalbuminuria (46%)" among the five measures examined. When examining the physicians open-ended comments, the main issues that were cited for noncompliance were physician oversight, patient non adherence, and systems issues. Physicians did admit that sometimes there is a conscious decision made to not comply due to the patient's age, comorbid illness or other factors. The study concludes that "even among a self-selected group of physicians, noncompliance with best practices in diabetes is common" and that physicians often disagree about what constitutes "best practice".
Posts
It would be interesting to know the process that the research group used to determine "best practices" for these patients as there seems to be a fair amount of professional disagreement on the subject. Is this disagreement a weakness of best practices overall, or was the initial application of best practices methodology imperfect?
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