Larme A C, Pugh J A
Department of Orthodontics, University of Texas Health Science Center at San Antonio, 78284-7910, USA.
Diabetes Care. 1998 Sep;21(9):1391-6. doi: 10.2337/diacare.21.9.1391.
Primary care providers have been slow to adopt standards of care for diabetes, and continuing medical education (CME) programs have been minimally effective in changing provider behavior. The objective of this study was to explore the previously reported finding that attitudes, rather than knowledge, may impede primary care provider adherence to standards of care.
Study participants included 31 primary care providers attending an eight-session CME program on diabetes. Providers rated on a 10-point scale how the treatment of diabetes compared with that of five other chronic conditions (hypertension, hyperlipidemia, angina, arthritis, and heart failure; 1 = easier to 10 = harder; midpoint 5.5). In a subsequent open-ended qualitative interview, providers explained their scale ratings.
Diabetes was rated as significantly harder to treat than hypertension (24 of 30 >5.5; P < 0.001) and angina (20 of 30 >5.5; P = 0.03). A majority also rated hyperlipidemia (18 of 30) and arthritis (18 of 30) as easier to treat than diabetes. Explanatory themes underlying provider frustrations with diabetes include characteristics of the disease itself and the complexity of its management, and a perceived lack of support from society and the health care system for their efforts to control diabetes.
CME that addresses provider attitudes toward diabetes in addition to updating knowledge may be more effective than traditional CME in promoting adherence to standards of care. Additional changes are needed in our health care system to shift from an acute to a chronic disease model to effectively support diabetes care efforts.
基层医疗服务提供者在采用糖尿病护理标准方面进展缓慢，继续医学教育（CME）项目在改变提供者行为方面效果甚微。本研究的目的是探讨先前报道的一个发现，即态度而非知识可能会阻碍基层医疗服务提供者遵守护理标准。
研究参与者包括31名参加为期八节的糖尿病CME项目的基层医疗服务提供者。提供者用10分制对糖尿病的治疗与其他五种慢性病（高血压、高脂血症、心绞痛、关节炎和心力衰竭；1=更容易，10=更难；中点为5.5）的治疗进行评分。在随后的开放式定性访谈中，提供者解释了他们的评分。
糖尿病被评为比高血压（30人中有24人评分>5.5；P<0.001）和心绞痛（30人中有20人评分>5.5；P=0.03）更难治疗。大多数人还认为高脂血症（30人中有18人）和关节炎（30人中有18人）比糖尿病更容易治疗。提供者对糖尿病感到沮丧的解释性主题包括疾病本身的特征及其管理的复杂性，以及他们认为社会和医疗保健系统在其控制糖尿病的努力方面缺乏支持。
除了更新知识外，针对提供者对糖尿病态度的CME可能比传统的CME在促进遵守护理标准方面更有效。我们的医疗保健系统需要进行更多变革，从急性病模式转变为慢性病模式，以有效地支持糖尿病护理工作。
