Helseth L D, Susman J L, Crabtree B F, O'Connor P J
University of Nebraska Medical Center, Department of Preventive and Societal Medicine, Omaha, USA.
J Fam Pract. 1999 Jan;48(1):37-42.
Studies demonstrate significant shortfalls in the quality of care for diabetes. Primary care physicians' views of the management of diabetes have been inadequately explored. The objective of our study was to describe primary care physicians' attitudes toward diabetes, patients with diabetes, and diabetes care.
In-depth interviews were conducted by a trained research interviewer with a sample of 10 family physicians and 9 internists in Connecticut. Interviews lasted an average of 60 minutes and were audiotaped and transcribed. Data were interpreted by a multidisciplinary team using a standard qualitative text analysis methodology. Themes from each interview were used to identify and develop overall themes related to the areas of inquiry.
Physicians' goals were congruent with current guidelines emphasizing the importance of good glycemic control and prevention of complications. However, physicians noted the challenge of balancing the multiple goals of ideal diabetes care and the realities of patient adherence, expectations, and circumstances. The majority of physicians described a patient-centered management style, but a substantial minority described a more paternalistic approach. Physicians did not identify or describe office systems for facilitating diabetes management. Differences between family physicians and internists did not emerge.
The complexity of diabetes care recommendations coupled with the need to tailor recommendations to individual patients produces wide variation in diabetes care. Improvement in care may depend on (1) prioritizing diabetes care recommendations for patients as individuals, (2) improving physicians' motivational counseling skills and enhancing their ability to deal with challenging patients, and (3) developing office systems and performance enhancement efforts that support cost-effective practice and patient adherence.
研究表明糖尿病护理质量存在显著不足。初级保健医生对糖尿病管理的看法尚未得到充分探讨。我们研究的目的是描述初级保健医生对糖尿病、糖尿病患者及糖尿病护理的态度。
一名经过培训的研究访谈员对康涅狄格州的10名家庭医生和9名内科医生进行了深入访谈。访谈平均持续60分钟，进行了录音和转录。一个多学科团队使用标准的定性文本分析方法对数据进行了解释。每次访谈的主题被用于识别和发展与研究领域相关的总体主题。
医生的目标与当前强调良好血糖控制和预防并发症重要性的指南一致。然而，医生们指出了在平衡理想糖尿病护理的多个目标与患者依从性、期望和实际情况之间的挑战。大多数医生描述了以患者为中心的管理方式，但有相当少数医生描述了更家长式的方法。医生们没有识别或描述促进糖尿病管理的办公室系统。家庭医生和内科医生之间没有出现差异。
糖尿病护理建议的复杂性，加上需要根据个体患者调整建议，导致糖尿病护理存在很大差异。护理的改善可能取决于：（1）将糖尿病护理建议按患者个体进行优先排序；（2）提高医生的动机咨询技能并增强他们应对具有挑战性患者的能力；（3）开发支持成本效益高的实践和患者依从性的办公室系统和绩效提升措施。
