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October 25, 2010

Diabetes Care Misses Mark in HIV Patients

IDSA from MedPage Today: "In scrutinizing how well different types of doctors did in providing routine care, researchers found that only doctors at a Canadian endocrinology clinic came anywhere near meeting treatment benchmarks.

"For example, when it came to foot examinations -- a key part of diabetes surveillance -- the check was done less than 20% of the time at a Toronto immunodeficiency clinic and an American HIV clinic; about 35% of the time at an American primary care clinic; about 65% of the time at an American endocrinology clinic, and about 90% of the time at the Canadian endocrinology clinic."


Rick Loftus, M.D. said...

I'll look forward to reading the original research, but to play Devil's Advocate for a moment: How do we know that mechanically checking feet means "quality"? I grant it indicates a certain thoroughness, but could it be that more critical tasks were prioritized better in the clinics who scored "poorly" on foot-checking? And to be fair to the HIV clinics, the endocrine folks would not be able to SPELL the antiretrovirals, much less prescribe them. HIV specialists wind up having to be specialists in everything now, and it's not easy. Also, the endocrine folks probably had 30 minutes per visit, minimum, and probably saw 6-10 cases per session, instead of the 10-14 that the primaries probably saw, with 12 minutes per case.