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Gearing Up for Better Diabetes Care in 2000.

FPs often don't order monitoring tests.

ORLANDO, FLA. -- It's time for family physicians to gear up for better diabetes care in the year 2000.

FPs score poorly when it comes to ordering appropriate monitoring tests for diabetic patients, according to findings from a study of 5,541 patients in Pennsylvania, New Jersey, and Delaware.

Fewer than one in six of the patients seen by an FP received an eye exam or recommended tests of cholesterol or glycosylated hemoglobin during the 1-year study, Dr. Angela Saldarriaga reported at the annual meeting of the American Academy of Family Physicians.

The finding underscores the need for tools such as computerized reminders to help physicians better track patients with chronic diseases, Dr. Saldarriaga said.

Such tools will become even more important next year, when new standards for diabetes care that were developed by the Diabetes Quality Improvement Project (DQIP) are slated to take effect.

The project was started by a coalition that included the American Diabetes Association, the Foundation for Accountability, the Health Care Financing Administration, and the National Committee for Quality Assurance (NCQA). The American Academy of Family Physicians and the American College of Physicians-American Society of Internal Medicine are on the DQIP steering committee.

Starting in January, the NCQA will require HMOs to report on a set of six "accountability measures" of diabetes care as part of the Health Plan Employer Data and Information Set (HEDIS). HCFA will mandate the use of eight measures for Medicare patients in managed care plans.

The list of new accountability measures includes annual testing of hemoglobin [A.sub.1c], annual eye exams, and lipid profile testing--similar to the indicators that Dr. Saldarriaga reported on.

In the study, investigators used administrative claims data from a large private insurance plan to select patients aged 30-64 years who were continuously insured and made at least one office or clinic visit during the 1-year study. Diabetes was defined as the presence of at least two separate diagnoses of diabetes during the study year.

Family physicians made up 32% of the physicians. The other physicians were general internists (40%), general practitioners (10%), endocrinologists (6%), and "other specialists" (5%).

The specialty was unknown in some cases, said Dr. Saldarriaga, a research assistant with Christiana Care Health System, Wilmington, Del.

She presented the findings on behalf of Dr. James Gill, also of Christiana.

Among the overall study population, only 20% of patients received a glycosylated hemoglobin test during the year, 18% received a cholesterol test, and 10% received an eye exam, she said.

Patients of family physicians were unlikely to receive a cholesterol test (16%, compared with 18%-25% for others) and an eye exam (8%, compared with 10%-21% for others).

Patients of FPs also had the lowest likelihood of receiving glycosylated hemoglobin tests with the exception of patients of "other specialists" (16%, compared with 15%-39%). General internists performed slightly better than their FP counterparts on all three measures.

Patients of endocrinologists were the most likely to receive a glycosylated hemoglobin test and a cholesterol test. Patients of "other specialists" were the most likely to receive an eye exam.

Endocrinologists fared better because their patients are "more motivated to manage their diabetes," Dr. Gill commented in an interview.

In contrast, most patients in the study who saw a family physician had scheduled the visit for an unrelated condition, so their diabetes "didn't always get dealt with," he said.
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Publication:Family Practice News
Date:Nov 1, 1999
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