title: Physician explanations for failing to comply with "best practices".
abstract: BACKGROUND
  Substantial effort has been devoted to improving physician compliance with evidence-based guidelines.
  
  
  OBJECTIVE
  To explore physicians' reasons for not following so-called "best practices" in caring for patients with type 2 diabetes.
  
  
  METHODS
  Descriptive study of self-assessed compliance with five measures of performance.
  
  
  METHODS
  Eighty-five internists who volunteered to participate in a practice-based research network created to improve clinical practice.
  
  
  METHODS
  Physicians reviewed their own charts of patients with type 2 diabetes mellitus (1755 patient encounters) to assess compliance and offered open-ended comments concerning their reasons for not complying with "best practices."
  
  
  RESULTS
  The physician volunteers reported not complying with the annual foot examination in 13% of encounters. A similar level of noncompliance was reported for the annual lipid profile (15%) and retinal examination (17%). Among the five measures examined, noncompliance was most common for screening urinalysis (26%) and screening microalbuminuria (46%). The physicians' open-ended comments suggested that physician oversight, patient nonadherence, and systems issues were common reasons for noncompliance. However, noncompliance also resulted from a conscious decision by the physician, as indicated by comments about patient age and comorbid illness or, with nephropathy screening, established renal disease or current therapy with angiotensin-converting enzyme inhibitors.
  
  
  CONCLUSIONS
  Even among a self-selected group of physicians, noncompliance with best practices in diabetes is common. Although physician forgetfulness and external factors are frequently offered as reasons for noncompliance, it may also result from a conscious decision, as physicians may disagree about what constitutes "best practices."
authors.affiliation: American College of Physicians-American Society of Internal Medicine, Department of Scientific Policy, Philadelphia, Penn., USA. cmotturpilson@mail.acponline.org
authors.forename: C
authors.initials: C
authors.lastname: Mottur-Pilson
authors.forename: V
authors.initials: V
authors.lastname: Snow
authors.forename: K
authors.initials: K
authors.lastname: Bartlett
mesh_terms: D001291:Attitude of Health Personnel; D019985:Benchmarking; D003657:Decision Making; D003924:Diabetes Mellitus, Type 2 / Q000517:prevention & control / Q000628:therapy*; D003954:Diagnostic Services / Q000706:statistics & numerical data; D019317:Evidence-Based Medicine; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D007388:Internal Medicine / Q000592:standards* / Q000706:statistics & numerical data; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D010820:Physicians / Q000523:psychology*; D014481:United States