Encounters by patients with type 2 diabetes--complex and demanding: an observational study

Abstract

Purpose: We wanted to examine the relationships between quality of diabetes care delivered, the type and length of encounter, and time to the next follow-up encounter.

Methods: The content of the physician-patient encounter was directly observed in 20 primary care clinics for 211 patients with type 2 diabetes mellitus. The quality of diabetes care was measured as the percentage of the 5 following services delivered during the encounter if they had not been offered in the previous year: foot examination, referral for an eye examination, a glycosylated hemoglobin (HbA1c) measurement, a lipid panel, and a urine microalbumin test.

Results: All indicated services were performed in 33% of encounters. Compared with encounters for an acute illness, patients visiting for chronic disease follow-up were 4.8 (95% CI, 1.95%-12.01%) times more likely to receive 100% of all indicated services. Length of encounter was associated with percentage of services delivered, but only during chronic disease follow-up encounters (P = .02). Encounters during which 100% of all indicated services were delivered had a mean length of 19.4 minutes. The time to the next scheduled encounter was shorter if fewer services were delivered during the observed encounter (P = .009).

Conclusions: Competing demands during primary care encounters require patient and physician to prioritize services delivered and defer indicated services to subsequent visits. Current models of patient care in primary care settings are inadequate to address the multitude of tasks facing clinicians, especially among patients with complex chronic illnesses. Innovative approaches and new models are needed to improve the quality of diabetes care.

Figure 1.

Time to next appointment and indicated services delivered.