Evidence-based guidelines meet the real world: The case of diabetes care

Anne C. Larme, Jacqueline A Pugh

Research output: Contribution to journalArticle

55 Citations (Scopus)

Abstract

OBJECTIVE - Improving diabetes care in the U.S. is critical because diabetes rates are increasing dramatically, particularly among minority and low-income populations. Although evidence-based practice guidelines for diabetes have been widely disseminated, many physicians fail to implement them. The objective of this study was to explore what happens to diabetes practice guidelines in real-world clinical settings. RESEARCH DESIGN AND METHODS - A qualitative research design was used. Open-ended semistructured interviews lasting 1-2 h were conducted with 32 key informants (physicians, certified diabetes educators, researchers, and agency personnel) selected for their knowledge of diabetes care in South Texas, an area with a high diabetes prevalence and a large proportion of minority and low-income patients. RESULTS - Health professionals stress that contextual factors are more important barriers to optimal diabetes care than physician knowledge and attitudes. Barriers exist at multiple levels and are interrelated in a complex manner. Examples include the following: time constraints and practice economics in the private practice setting; the need to maintain referral relationships and maldistribution of professionals in the practice community; low awareness and low socioeconomic status among patients; and lack of access for low-income patients, low reimbursement, and insufficient focus on prevention in the U.S. health care system. CONCLUSIONS - Contextual barriers must be addressed in order for diabetes practice guidelines to be implemented in real-world clinical practice. Suggested changes include an increased focus on prevention, improvements in health care delivery for chronic diseases, and increased attention to the special needs of minority and low-income populations.

Original languageEnglish (US)
Pages (from-to)1728-1733
Number of pages6
JournalDiabetes Care
Volume24
Issue number10
StatePublished - 2001

Fingerprint

Practice Guidelines
Guidelines
Poverty
Physicians
Research Design
Delivery of Health Care
Professional Practice
Qualitative Research
Evidence-Based Practice
Private Practice
Social Class
Chronic Disease
Referral and Consultation
Economics
Research Personnel
Interviews
Health

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Internal Medicine

Cite this

Larme, A. C., & Pugh, J. A. (2001). Evidence-based guidelines meet the real world: The case of diabetes care. Diabetes Care, 24(10), 1728-1733.

Evidence-based guidelines meet the real world : The case of diabetes care. / Larme, Anne C.; Pugh, Jacqueline A.

In: Diabetes Care, Vol. 24, No. 10, 2001, p. 1728-1733.

Research output: Contribution to journalArticle

Larme, AC & Pugh, JA 2001, 'Evidence-based guidelines meet the real world: The case of diabetes care', Diabetes Care, vol. 24, no. 10, pp. 1728-1733.
Larme, Anne C. ; Pugh, Jacqueline A. / Evidence-based guidelines meet the real world : The case of diabetes care. In: Diabetes Care. 2001 ; Vol. 24, No. 10. pp. 1728-1733.
@article{d9ef98ba9e114ed6bf48b67cd8a9f81f,
title = "Evidence-based guidelines meet the real world: The case of diabetes care",
abstract = "OBJECTIVE - Improving diabetes care in the U.S. is critical because diabetes rates are increasing dramatically, particularly among minority and low-income populations. Although evidence-based practice guidelines for diabetes have been widely disseminated, many physicians fail to implement them. The objective of this study was to explore what happens to diabetes practice guidelines in real-world clinical settings. RESEARCH DESIGN AND METHODS - A qualitative research design was used. Open-ended semistructured interviews lasting 1-2 h were conducted with 32 key informants (physicians, certified diabetes educators, researchers, and agency personnel) selected for their knowledge of diabetes care in South Texas, an area with a high diabetes prevalence and a large proportion of minority and low-income patients. RESULTS - Health professionals stress that contextual factors are more important barriers to optimal diabetes care than physician knowledge and attitudes. Barriers exist at multiple levels and are interrelated in a complex manner. Examples include the following: time constraints and practice economics in the private practice setting; the need to maintain referral relationships and maldistribution of professionals in the practice community; low awareness and low socioeconomic status among patients; and lack of access for low-income patients, low reimbursement, and insufficient focus on prevention in the U.S. health care system. CONCLUSIONS - Contextual barriers must be addressed in order for diabetes practice guidelines to be implemented in real-world clinical practice. Suggested changes include an increased focus on prevention, improvements in health care delivery for chronic diseases, and increased attention to the special needs of minority and low-income populations.",
author = "Larme, {Anne C.} and Pugh, {Jacqueline A}",
year = "2001",
language = "English (US)",
volume = "24",
pages = "1728--1733",
journal = "Diabetes Care",
issn = "1935-5548",
publisher = "American Diabetes Association Inc.",
number = "10",

}

TY - JOUR

T1 - Evidence-based guidelines meet the real world

T2 - The case of diabetes care

AU - Larme, Anne C.

AU - Pugh, Jacqueline A

PY - 2001

Y1 - 2001

N2 - OBJECTIVE - Improving diabetes care in the U.S. is critical because diabetes rates are increasing dramatically, particularly among minority and low-income populations. Although evidence-based practice guidelines for diabetes have been widely disseminated, many physicians fail to implement them. The objective of this study was to explore what happens to diabetes practice guidelines in real-world clinical settings. RESEARCH DESIGN AND METHODS - A qualitative research design was used. Open-ended semistructured interviews lasting 1-2 h were conducted with 32 key informants (physicians, certified diabetes educators, researchers, and agency personnel) selected for their knowledge of diabetes care in South Texas, an area with a high diabetes prevalence and a large proportion of minority and low-income patients. RESULTS - Health professionals stress that contextual factors are more important barriers to optimal diabetes care than physician knowledge and attitudes. Barriers exist at multiple levels and are interrelated in a complex manner. Examples include the following: time constraints and practice economics in the private practice setting; the need to maintain referral relationships and maldistribution of professionals in the practice community; low awareness and low socioeconomic status among patients; and lack of access for low-income patients, low reimbursement, and insufficient focus on prevention in the U.S. health care system. CONCLUSIONS - Contextual barriers must be addressed in order for diabetes practice guidelines to be implemented in real-world clinical practice. Suggested changes include an increased focus on prevention, improvements in health care delivery for chronic diseases, and increased attention to the special needs of minority and low-income populations.

AB - OBJECTIVE - Improving diabetes care in the U.S. is critical because diabetes rates are increasing dramatically, particularly among minority and low-income populations. Although evidence-based practice guidelines for diabetes have been widely disseminated, many physicians fail to implement them. The objective of this study was to explore what happens to diabetes practice guidelines in real-world clinical settings. RESEARCH DESIGN AND METHODS - A qualitative research design was used. Open-ended semistructured interviews lasting 1-2 h were conducted with 32 key informants (physicians, certified diabetes educators, researchers, and agency personnel) selected for their knowledge of diabetes care in South Texas, an area with a high diabetes prevalence and a large proportion of minority and low-income patients. RESULTS - Health professionals stress that contextual factors are more important barriers to optimal diabetes care than physician knowledge and attitudes. Barriers exist at multiple levels and are interrelated in a complex manner. Examples include the following: time constraints and practice economics in the private practice setting; the need to maintain referral relationships and maldistribution of professionals in the practice community; low awareness and low socioeconomic status among patients; and lack of access for low-income patients, low reimbursement, and insufficient focus on prevention in the U.S. health care system. CONCLUSIONS - Contextual barriers must be addressed in order for diabetes practice guidelines to be implemented in real-world clinical practice. Suggested changes include an increased focus on prevention, improvements in health care delivery for chronic diseases, and increased attention to the special needs of minority and low-income populations.

UR - http://www.scopus.com/inward/record.url?scp=0035487748&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0035487748&partnerID=8YFLogxK

M3 - Article

C2 - 11574433

AN - SCOPUS:0035487748

VL - 24

SP - 1728

EP - 1733

JO - Diabetes Care

JF - Diabetes Care

SN - 1935-5548

IS - 10

ER -