Comparison of diabetes care provided by an endocrinology clinic and a primary-care clinic.
OBJECTIVE
To compare the quality of ambulatory diabetes care provided by physicians in an endocrinology clinic with that in a primary-care clinic.


METHODS
We conducted a retrospective study of the medical records of patients with diabetes treated for 2 to 4 years in an endocrinology clinic and a primary-care clinic at an academic medical center. Adherence to American Diabetes Association (ADA) clinical practice recommendations and hemoglobin A(1c) (HbA(1c)) levels were assessed in randomly chosen patients-a total of 68 patients from the primary-care clinic and 105 patients from the endocrinology clinic, with total patient-years of follow-up of 241 and 370, respectively.


RESULTS
In six of seven areas assessed, the endocrinology clinic was significantly more compliant with ADA recommendations than was the primary-care clinic: queries about hypoglycemia (88% versus 20%); frequency of glycated hemoglobin determinations (3.3 versus 2.1 per patient/yr); yearly lipid panel (44% versus 25%); and yearly ophthalmologic (90% versus 50%), neurologic (56% versus 37%), and foot (88% versus 59%) examinations (all P<0.001). The rate of yearly proteinuria evaluations was similar in the two clinics (66% versus 65%). On assessment of all patients, the mean HbA(1c) level was significantly lower in the endocrinology clinic (8.29%) than in the primary-care clinic (8.73%) (P = 0.01).


CONCLUSIONS
Adherence to ADA clinical practice recommendations was significantly better in the endocrinology clinic than in the primary-care clinic. This finding and the significantly lower levels of HbA(1c) in patients in the endocrinology clinic setting would be expected to translate into improved long-term patient outcome.
Leinung
M C
MC
Department of Medicine, Albany Medical College, Albany, New York 12208-3479, USA.
Gianoukakis
A G
AG
Lee
D W
DW
Jeronis
S L
SL
Desemone
J
J
D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000378:metabolism; D003920:Diabetes Mellitus / Q000628:therapy*; D004704:Endocrinology; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D008297:Male; D008875:Middle Aged; D010044:Outpatient Clinics, Hospital; D010349:Patient Compliance; D011320:Primary Health Care; D011507:Proteinuria / Q000378:metabolism; D011787:Quality of Health Care; D012189:Retrospective Studies
D001786:Blood Glucose; D006442:Glycated Hemoglobin