Primary Care

Primary care practice structure affects control of risk factors for cardiovascular disease among patients with diabetes

Primary care practices that have teams with well-defined leadership and effective teamwork, where the appointment and visit systems are well structured, and where followup and coordination of care after the visit are well planned, seemed to be better at controlling risk factors for cardiovascular (CV) disease among patients with diabetes, concludes a new study.

Michael Parchman, M.D., M.P.H., of the University of Texas Health Science Center at San Antonio, and Amer A. Kaissi, Ph.D., of Trinity University, found that a primary care practice's community connections and its actual delivery of care during a patient's visit were linked to good control of three CV risk factors among patients with diabetes: glycosylated hemoglobin or A1C (a measure of blood-sugar level), blood pressure (BP), and low-density lipoprotein (LDL) cholesterol. These practice characteristics improved the likelihood of CV risk control by 65 percent and 38 percent, respectively. However, practice use of clinical information systems (such as disease registries and provider reminders) reduced by 42 percent the likelihood of good control.

The researchers suggest that use of clinical information systems during a medical visit may compete with time devoted to addressing patient needs and concerns. They asked patients with Type 2 diabetes from 20 Texan primary care clinics about their stage of change for 4 self-care behaviors: diet, exercise, glucose monitoring, and medication adherence. Clinicians in each clinic completed the Assessment of Chronic Illness Care survey about use of the six Chronic Care Model components used in their clinic: organizational support, patient self-management support, delivery system design (actual delivery of care), decision support, clinical information systems, and community linkages (for example, with diabetes specialists and educators). Overall, only 13 percent of the 618 patients studied had good control of all 3 CV risk factors. The study was supported in part by the Agency for Healthcare Research and Quality (HS13008).

See "Are elements of the chronic care model associated with cardiovascular risk factor control in type 2 diabetes?" by Drs. Parchman and Kaissi, in the March 2009 Joint Commission Journal on Quality and Patient Safety 35(3), pp. 133-138.

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