Corriere Mark D, Minang Laura B, Sisson Stephen D, Brancati Frederick L, Kalyani Rita Rastogi
Division of Endocrinology, Diabetes, & Metabolism, Johns Hopkins University School of Medicine, 1830 East Monument Street, Suite 333, Baltimore, Maryland 21287, USA.
BMC Med Educ. 2014 Sep 8;14:186. doi: 10.1186/1472-6920-14-186.
Clinical guidelines for type 2 diabetes are a resource for providers to manage their patients and may help highlight specific areas in need of further education and training. We sought to determine how often guidelines are used and the relationship to physicians' diabetes-related knowledge and decision making.
Existing users of electronic clinical support tools were invited to complete an online questionnaire. A knowledge score was calculated for five questions related to prevention of diabetes and treatment of its complications. We explored the association of clinical guideline use with diabetes-related knowledge and self-reported decision making using logistic regression models, adjusted for key covariates.
Of 383 physicians completing the questionnaire, 53% reported using diabetes guidelines routinely. Mean diabetes knowledge score for guideline users (GU) was significantly higher than non-guideline users (NGU) (3.37 ± 0.072 vs. 2.76 ± 0.084; p < 0.001). GU were significantly more likely to report a good understanding of type 2 diabetes medications (OR = 2.99, 95% CI 1.95-4.61; p < 0.001). GU were less likely to report their unfamiliarity with insulin as an important barrier to early insulin use (OR = 0.41, 0.21-0.80; p = 0.007) and with pharmacologic options as a barrier to prescribing intensive multifactorial interventions (OR = 0.32, 0.17-0.58; p < 0.001). Associations remained significant after adjusting for physician specialty, practice volume and frequency diagnosing or treating diabetes patients.
Significant gaps exist in diabetes-related knowledge and decision making among practicing physicians, as highlighted by clinical guideline use. The development of educational and training strategies to address these needs may ultimately improve outcomes for patients with diabetes and should be investigated in the future.
2型糖尿病临床指南是医疗服务提供者管理患者的资源，可能有助于突出需要进一步教育和培训的特定领域。我们试图确定指南的使用频率以及与医生糖尿病相关知识和决策的关系。
邀请电子临床支持工具的现有用户完成一份在线问卷。计算了与糖尿病预防及其并发症治疗相关的五个问题的知识得分。我们使用逻辑回归模型，在调整关键协变量后，探讨了临床指南使用与糖尿病相关知识和自我报告决策之间的关联。
在完成问卷的383名医生中，53%报告经常使用糖尿病指南。指南使用者（GU）的平均糖尿病知识得分显著高于非指南使用者（NGU）（3.37±0.072对2.76±0.084；p<0.001）。GU更有可能报告对2型糖尿病药物有良好的理解（OR=2.99，95%CI 1.95-4.61；p<0.001）。GU不太可能报告他们对胰岛素不熟悉是早期使用胰岛素的重要障碍（OR=0.41，0.21-0.80；p=0.007），也不太可能报告药物选择是开具强化多因素干预措施的障碍（OR=0.32，0.17-0.58；p<0.001）。在调整医生专业、工作量以及诊断或治疗糖尿病患者的频率后，这些关联仍然显著。
临床指南的使用凸显了执业医生在糖尿病相关知识和决策方面存在显著差距。制定满足这些需求的教育和培训策略可能最终改善糖尿病患者的治疗效果，未来应进行研究。
