Patient-centered guidelines for geriatric diabetes care: Potential missed opportunities to avoid harm

Ellen M. McCreedy, Robert L Kane, Sarah E Gollust, Nathan D Shippee, Kirby D Clark

Research output: Contribution to journalArticlepeer-review

3 Scopus citations

Abstract

Background: Clinicians strive to deliver individualized, patient-centered care. However, these intentions are understudied. This research explores how patient characteristics associated with an high riskto-benefit ratio with hypoglycemia medications affect decision making by primary care clinicians. Methods: Using a vignette-based survey, we queried primary care clinicians on their intended management of geriatric patients with diabetes. The patients' ages, disease durations, and comorbidities were systematically varied. Clinicians indicated whether they would intensify glycemic control by adding a second-line hypoglycemia medication. Results: A convenience sample of 336 primary care clinicians completed the survey. Despite the recommendations for HbA1c targets <8% for more complex patients, an 80-year-old woman with an HbA1c of 7.5%, longstanding diabetes, coronary disease, and cognitive impairment and with instrumental activity of daily living dependencies, had a predicted probability of treatment intensification of 35%. Internists were 11% and nurse practitioners were 14% more likely to intensify treatment than family physicians (P < .01). These provider differences remained significant after controlling for geographic differences in treatment intensification. Providers in Florida were more likely to intensify treatment (P < .01). Conclusions: Primary care clinicians often chose to intensify glycemic control despite individual patient factors that warrant higher glycemic targets based on existing guidelines. This research identifies possible missed opportunities for patient-centered goal setting and raises questions about the influence of training and practice environment on clinical decision making.

Original languageEnglish (US)
Pages (from-to)192-200
Number of pages9
JournalJournal of the American Board of Family Medicine
Volume31
Issue number2
DOIs
StatePublished - Mar 1 2018

Bibliographical note

Funding Information:
Funding: EMM is supported by an Agency for Healthcare Research and Quality National Research Service Award (4T32 HS000011-30). Conflict of interest: none declared. Corresponding author: Ellen M. McCreedy, PhD, Center for Gerontology and Healthcare Research, Brown University, School of Public Health, 121 South Main Street, Suite 6, Providence, RI 02903 (E-mail: ellen_mccreedy@brown. edu).

Keywords

  • Blood glucose
  • Clinical decision-making
  • Diabetes mellitus
  • Geriatric health services
  • Hyperglycemia
  • Hypoglycemic agents
  • Patient-centered care
  • Primary health care

Fingerprint Dive into the research topics of 'Patient-centered guidelines for geriatric diabetes care: Potential missed opportunities to avoid harm'. Together they form a unique fingerprint.

Cite this