Abstract
Objective
To explore how clinical and demographic variables impact on the management of diabetes
mellitus in general practice.
Design
A structured vignette survey was conducted in Australia. This included nine vignettes
chosen at random from 128 developed around seven clinical variables. Respondents were
asked to recommend a change in treatment and make specific recommendations. A random
sample of general practitioners (GPs) were recruited. Two diabetologists involved
in the development of national guidelines also participated.
Results
125 (13.8%) GPs participated. Statistical analyses were used to generate outcome measures.
GPs recommended a change in treatment for most (81.1%) cases; were less likely to
prescribe a statin (68.5% GPs vs. 76.3% diabetologists), less likely to treat hypertension
(66.7% vs.89%) and less likely to refer for lifestyle modification (82.3% vs. 96.5%).
Significant disagreement occurred around prescribing or changing oral hypoglycaemics.
No GP characteristics showed significant impact. The proportion of GPs who agreed
with diabetiologists on dose and choice of drugs was 35.7% for statins, 49.6% for
antihypertensives and 39.6% for oral hypoglycaemics.
Conclusions
There were significant differences between diabetologists and GPs on the management
of diabetes. The survey suggests significant under-dosing by GPs. These findings warrant
further investigation.
Keywords
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Article info
Publication history
Published online: December 07, 2011
Accepted:
November 7,
2011
Received in revised form:
October 31,
2011
Received:
September 5,
2011
Identification
Copyright
© 2011 Elsevier Ireland Ltd. Published by Elsevier Inc. All rights reserved.
