מתוך medicontext.co.il
WESTPORT, CT (Reuters Health) – Physicians treating patients with type 2 diabetes often do not follow "best practices," according to researchers from the American College of Physicians–American Society of Internal Medicine. Sometimes the reason for not complying is simply disagreement with what constitutes best practice.
Dr. Christel Mottur-Pilson and colleagues from Philadelphia collected data on 85 internists who volunteered to review their own records of 1755 encounters with type 2 diabetic patients.
In 13% of the patient encounters, an annual foot exam was not performed; in 15%, no lipid profile was obtained; and in 17% of the patient encounters, there was no retinal examination. Noncompliance was most common in screening urinalysis (26%) and in screening microalbuminuria (46%), the researchers report.
The physicians reported their reasons for not complying with "best practices." As reported in the September/October issue of Effective Clinical Practice., in some cases noncompliance "was a conscious decision by the physician, as indicated by comments about patient age and comorbid illness."
"Many patients present with multiple morbidities," Dr. Mottur-Pilson commented to Reuters Health. "It becomes an issue of which condition is perceived as most important at the time of the encounter. Since the average physician visit is only about 16 minutes, the physician has to limit his interaction to the most pressing problem," she explained.
"'Best practice' results from clinical trials but do not apply in the average physician office," Dr. Mottur-Pilson noted. "Each patient is an individual and while most best-practice guidelines apply to most patients, patients do vary," she elaborated.
Some of the other reasons physicians did not comply with "best practice" had to do with the fact that there is an unstable patient population, Dr. Mottur-Pilson said. Many patients do not maintain a continuity of care, so the transfer of records is not always complete, she added.
Physicians also reported that patient noncompliance with treatment, missed appointments, problems with insurance and other healthcare system problems also resulted in noncompliance with "best practice."
"The way the current healthcare system is structured does not make it easy to achieve 'best practice,'" Dr. Mottur-Pilson said. Perhaps if physicians were paid by time rather than by diagnostic code the situation could be improved, she added.
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