Problem: Studies suggest that primary care physician-patient encounters arecharacterized by competing demands that force clinicians to prioritize andaddress the most pressing problems. We hypothesize that patients with type 2diabetes seen in primary care clinics with worse health status will have a higherlevel of competing demands, a greater number of visits over the prior 12 monthsand lower quality of care.
Participants: 30 patients with type 2 diabetes presenting to 18 primary careclinics.
Data Collection: Patient exit survey, medical chart abstraction for all subjectsand direct observation of the visit for the first 8-10 subjects in each clinic.
Outcome Measures: A single-item question from the SF-36 was used tomeasure general health status. A quality of care score was calculated from chartabstraction data for each patient based on the American Diabetes Association’sPhysician Recognition Program criteria(range 0-110). Number of patientsymptoms and complaints were recorded for the directly observed visits.
• The mean number of clinic visits over the prior 12 months was 6.6 (S.D. 3.8).
• 42.4% rated their overall health status as fair or poor.
• There were no significant differences in age, number of diagnoses or number ofmedications by health status.
• Patients with excellent overall general health status had a mean of 0.5 (S.D. 0.7)complaints during each encounter. Those with poor health status had a mean of 4.8(S.D. 2.1) complaints. (Figure 1)
• Those with fair or poor health status had a significantly higher number of visits,7.3(S.D. 4.3) in the past 12 months compared to those who rated their health asgood, very good or excellent with a mean of 6.0(S.D. 3.3) visits.(t-test = -3.36,p<.001). (Figure 2)
• In spite of this higher number of visits, those with worse health status also had asignificantly lower quality of care score, 52.6(S.D. 14.2) compared to those withbetter overall health, 56.2(S.D. 11.3).(t-test = 2.90, p = .004) (Figure 3)
• In a regression model, both number of visits and health status are related to thequality of care score, (see Table 1) but only explain a small proportion of the variance(R-sqaure = .06)
Self-rated overall general health status of patients with type 2 diabetes is associatedwith the quality of diabetes care, independent of the number of visits.
Number of visits and self-rated health status explain only a small amount of thevariation in quality of care. Self-rated health status may be an inadequate measure ofthe level of competing demands during visits.
Patients with fair or poor overall health status may require more frequent visits toachieve the same quality of care received by those whose health status is good, verygood or excellent.
Results
Results
Background and Methods
Background and Methods
Conclusions
Conclusions
Results
Results
Figure 1
Figure 1
Figure 3
Figure 3
Figure 2
Figure 2
Table 1
Table 1
Competing Demands and the Quality of Diabetes Care
In Primary Care Settings: A STARNet Study
Michael L. Parchman, MD, MPH;
Jacqueline A. Pugh, MD; Raquel Romero, MD
Competing Demands and the Quality of Diabetes Care
In Primary Care Settings: A STARNet Study
Michael L. Parchman, MD, MPH;
Jacqueline A. Pugh, MD; Raquel Romero, MD
Acknowledgement: Funding for this study was provided by AHRQ, Grant # K08HS013008-02; HRSA Grant # 5D12HP00008-02; the Department of Veteran Affairs,HSR&D; and the South Texas Health Research Center. Special thanks to thephysicians and office staff of the South Texas Ambulatory Research Network(STARNet) Contact email: parchman@uthscsa.edu
