Kimberly A Zoberi1, Joanne Salas1, Cassie N Morgan1, Jeffrey F Scherrer1. 1. Kimberly A. Zoberi, MD, Joanne Salas, MPH, Cassie N. Morgan, MSW, and Jeffrey F. Scherrer, PhD, are in the Department of Family and Community Medicine, Saint Louis University School of Medicine.
Abstract
The majority of patients with type 2 diabetes are managed in primary care, either in family medicine (FM) or general internal medicine (GIM). Variances in training, beliefs and practice decisions between FM and GIM may result in differing approaches to diabetes management. This study found that differences do exist in the choice of treatment by FM vs GIM; however, these differences are driven by patient characteristics and does not result in glycemic control disparities. BACKGROUND AND OBJECTIVES: Approach to management of chronic health conditions differs between family medicine (FM) and general internal medicine (GIM). Differences might be due to beliefs, patient case mix, training, and/or experience. This study determined if FM and GIM diabetes management differences exist, and if so, resulted in better or worse glycemic control. METHOD: Electronic medical record data from 2008-2013 were used to identify 976 patients (287 FM and 689 GIM) with type 2 diabetes and prescriptions for metformin. GEE-type regression models were computed to control for repeated measures and estimate the association between primary care specialty and glycemic control, defined as percent of patients with HgA1c<8.5 and average HgA1c. Covariates included demographics, comorbidities, smoking and health care utilization, and diabetes treatment. RESULTS: Compared to FM patients, significantly more GIM patients received a non-metformin medication (35.9% vs 47.2%) and insulin (16.4% vs 23.8%). After adjusting for covariates, FM patients had significantly lower HgA1c values (B = -.47; 95% CI: -0.68, -0.27) and were less likely to have an HgA1c>8.5 (OR=0.55; 95%CI:0.40-0.77). FM vs GIM patients did not differ in degree of HgA1c improvement over time. CONCLUSIONS: FM patients vs GIM patients are less likely to receive a non-metformin and insulin medication. Differences in diabetes management likely correspond to degree of HgA1c control. Choice of treatment appears to reflect patient needs as both FM and GIM patients experienced equal improvement in HgA1c. Primary care specialty differences in beliefs and practices around diabetes management do not result in disparities in patient care.
The majority of patients with type 2 diabetes are managed in primary care, either in family medicine (FM) or general internal medicine (GIM). Variances in training, beliefs and practice decisions between FM and GIM may result in differing approaches to diabetes management. This study found that differences do exist in the choice of treatment by FM vs GIM; however, these differences are driven by patient characteristics and does not result in glycemic control disparities. BACKGROUND AND OBJECTIVES: Approach to management of chronic health conditions differs between family medicine (FM) and general internal medicine (GIM). Differences might be due to beliefs, patient case mix, training, and/or experience. This study determined if FM and GIM diabetes management differences exist, and if so, resulted in better or worse glycemic control. METHOD: Electronic medical record data from 2008-2013 were used to identify 976 patients (287 FM and 689 GIM) with type 2 diabetes and prescriptions for metformin. GEE-type regression models were computed to control for repeated measures and estimate the association between primary care specialty and glycemic control, defined as percent of patients with HgA1c<8.5 and average HgA1c. Covariates included demographics, comorbidities, smoking and health care utilization, and diabetes treatment. RESULTS: Compared to FM patients, significantly more GIM patients received a non-metformin medication (35.9% vs 47.2%) and insulin (16.4% vs 23.8%). After adjusting for covariates, FM patients had significantly lower HgA1c values (B = -.47; 95% CI: -0.68, -0.27) and were less likely to have an HgA1c>8.5 (OR=0.55; 95%CI:0.40-0.77). FM vs GIM patients did not differ in degree of HgA1c improvement over time. CONCLUSIONS: FM patients vs GIM patients are less likely to receive a non-metformin and insulin medication. Differences in diabetes management likely correspond to degree of HgA1c control. Choice of treatment appears to reflect patient needs as both FM and GIM patients experienced equal improvement in HgA1c. Primary care specialty differences in beliefs and practices around diabetes management do not result in disparities in patient care.
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