Disease management for diabetes among family physicians and general internists: opportunism or planned care?

Diabetes requires substantial ongoing medical management and use of monitoring tests. However, physicians' performance of these tests is often suboptimal. This study explored primary care physicians' management of diabetes in the context of both planned diabetes visits and acute visits for conditions unrelated to diabetes. Semi-structured depth interviews were conducted with 12 primary care physicians in 9 family practice and internal medicine practices distributed throughout the state of South Carolina. All interviews were tape recorded and transcribed. Themes, divergences, and trends were identified and discussed by the investigators. Although all participants reported a preference toward planned diabetes management, because most patients fail to adhere to scheduled care, opportunistic disease management tended to be the default mode of diabetes care. Participants reported performing appropriate tests during scheduled visits but acknowledged that when confined to acute visits, diabetes care was difficult to perform. Reasons included time constraints and patient agenda. Participants reported that inadequate tracking of completion of diabetes standards of care influenced their adherence to guidelines. The current system of delivering diabetes care opportunistically in the context of non-diabetes acute visits may need to be more closely examined in an effort to improve the delivery of services.