Table 1.

Major Themes and Exemplary Quotes from Family Physicians, Medical Directors, and Administrative Leaders About Challenges to Practicing Evidence-based Diabetes Self-Management Guidelines

Lack of easily retrievable electronic health information“We actually pull data ourselves and rely upon the health plan. It's complicated because they don't even know who our patients are…. I'm searching through all their information hoping that the electronic health record would solve all of this.”
Inadequate coordination with other providers within and outside the institution“[How we] get the information in an efficient way from, for example, the eye care providers that do our diabetic eye care…is a real challenge.”
Incentives to physicians are based on quantity of care not quality“So, if you say, we want you to deliver the best possible care for each patient, not, how many patients can you see every day, which is still how we ‘by large' get paid, the organization has to invest in that.”
Conflict between current physician practice and information in the guidelines, including self-management advice given to patients“I've had patients come back and say, ‘Well they told me to do that and now you're telling me to do this.'”
“The state or the ADA guidelines differ from the way we're practicing.”
  • ADA, American Diabetes Association.