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Research ArticleOriginal Research

The Decision to Intensify Therapy in Patients with Type 2 Diabetes: Results from an Experiment Using a Clinical Case Vignette

Richard W. Grant, Karen E. Lutfey, Eric Gerstenberger, Carol L. Link, Lisa D. Marceau and John B. McKinlay
The Journal of the American Board of Family Medicine September 2009, 22 (5) 513-520; DOI: https://doi.org/10.3122/jabfm.2009.05.080232
Richard W. Grant
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Karen E. Lutfey
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Eric Gerstenberger
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Carol L. Link
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Lisa D. Marceau
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John B. McKinlay
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Article Figures & Data

Tables

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    Table 1.

    Symptoms, Patient Behavior, and Clinical Data Embedded in the Diabetes Vignette “Diagnosed Diabetes with Complications”

    Patient SymptomsPatient BehaviorsClinical Data
    • Burning sensation at bottoms of feet and up one ankle

    • Foot pain is intermittent and hard to localize

    • Patient otherwise feeling “quite good”

    • Regularly tests glucose

    • Concerned about high blood pressure

    • Adherence to blood pressure medicine less than ideal

    • Patient is overweight

    • Last hemoglobin A1c level was 6.9%

    • Single high blood pressure reading (145/98)

    • View popup
    Table 2.

    Associations Between Patient, Physician, and Practice Characteristics and the Study Physician's Decision to Intensify Therapy to Treat Blood Pressure, Glycemia, Lipids, or Any of These Three Conditions After Viewing the Patient Vignette (n = 192)*

    Medication ChangesIntensified According to Vignette Patient Characteristics (%)
    MaleFemaleP35 years old65 years oldP
    Blood pressure5246.444454.20
    Glycemia2425.882227.46
    Lipids1813.321417.55
    Any of the 35550.524857.24
    Higher SES†Lower SES†PWhiteBlackHispanicP
    Blood pressure5147.61485247.89
    Glycemia2920.18282719.51
    Lipids2010.08171711.53
    Any of 35550.52555252.94
    Intensified According to Physician Characteristics (%)‡
    MaleFemalePLess ExperiencedMore ExperiencedP
    Blood pressure4652.445147.61
    Glycemia2326.662623.66
    Lipids1417.551318.32
    Any of 34956.365253.90
    Intensified According to Practice Factors (%)§
    For profit (n = 135)Other (n = 57)PSolo (n = 65)Small (n = 105)Large (n = 22)P
    Blood pressure4753.42455246.58
    Glycemia2425.68252714.39
    Lipids1418.15201214.68
    Any of 35058.30495646.47
    • * Numbers are proportions of respondents indicating that they would prescribe medications for each or any of the three diabetes-related risk factors; Numbers of physicians per practice variables are indicated in the table. Due to the factorial experimental design, numbers within each patient and physician variable category are equal.

    • † Socioeconomic status (SES) depicted by occupation of lawyer versus janitor.

    • ‡ Physician experience groups divided as ≤12 years vs ≥22 years of clinical experience.

    • § Practice sizes defined by number of physicians (1, ≤10, or >10).

    • View popup
    Table 3.

    Differences in Medication-Related Treatment Concerns Between Physicians Who Would or Would Not Prescribe Therapy for Vignette (n = 173)*

    Treatment Concerns (%)Would Study Physician Prescribe a Medicine for Vignette Patient to Treat:
    Glycemia?Blood Pressure?Anything Related to Diabetes?
    Yes (n = 45)No (n = 128)Yes (n = 85)No (n = 88)Yes (n = 92)No (n = 81)
    Financial barriers89†4975†4474†43
    Medication adherence71†5265†496349
    Need more clinical data11148181017
    Long-term risk for complications382537†203422
    • * Numbers are proportions of study physicians who discussed each of the 4 treatment concerns, categorized by whether the study physician would prescribe medications for the indicated diabetes-related conditions. “Anything related to diabetes” defined as medicines to treat hypertension, hyperglycemia, or hyperlipidemia.

    • † Difference between yes and no responses statistically significant (P < .05).

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The Journal of the American Board of Family Medicine: 22 (5)
The Journal of the American Board of Family Medicine
Vol. 22, Issue 5
September-October 2009
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The Decision to Intensify Therapy in Patients with Type 2 Diabetes: Results from an Experiment Using a Clinical Case Vignette
Richard W. Grant, Karen E. Lutfey, Eric Gerstenberger, Carol L. Link, Lisa D. Marceau, John B. McKinlay
The Journal of the American Board of Family Medicine Sep 2009, 22 (5) 513-520; DOI: 10.3122/jabfm.2009.05.080232

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The Decision to Intensify Therapy in Patients with Type 2 Diabetes: Results from an Experiment Using a Clinical Case Vignette
Richard W. Grant, Karen E. Lutfey, Eric Gerstenberger, Carol L. Link, Lisa D. Marceau, John B. McKinlay
The Journal of the American Board of Family Medicine Sep 2009, 22 (5) 513-520; DOI: 10.3122/jabfm.2009.05.080232
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