title: Differential adoption of pharmacotherapy recommendations for type 2 diabetes by generalists and specialists.
abstract: Newer, multimedication (novel) regimens provide better glycemic control for many type 2 diabetics when sulfonylurea monotherapy (traditional) becomes ineffective. Because better glycemic control is associated with decreased likelihood of complications and lower utilization and cost of care, the authors examined change in prescribing patterns for veterans with type 2 diabetes between FY 97 and 99. They classified medication regimens as traditional and novel based on the combination of diabetes medications patients received at the end of each year. Multivariate logistic regression analyses controlling for disease severity indicated that patients were more likely to receive novel regimens over time, but those seen only in primary care were less likely to receive novel regimens than those previously seen by a specialist. Geographic differences and differences in how recommendations were implemented by generalists and specialists suggest that diffusion of innovations theory may help explain variations in practice and guide interventions designed to translate research into practice.
authors.affiliation: Center for Health Quality, Outcomes, and Economic Research, Boston University School of Medicine, USA.
authors.forename: Mary Jo
authors.initials: MJ
authors.lastname: Pugh
authors.forename: Jennifer
authors.initials: J
authors.lastname: Anderson
authors.forename: Leonard M
authors.initials: LM
authors.lastname: Pogach
authors.forename: Dan R
authors.initials: DR
authors.lastname: Berlowitz
mesh_terms: D000368:Aged; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000188:drug therapy*; D004059:Diffusion of Innovation; D004359:Drug Therapy, Combination; D017723:Drug Utilization Review; D005194:Family Practice / Q000706:statistics & numerical data*; D005260:Female; D005431:Florida; D006442:Glycated Hemoglobin / Q000032:analysis / Q000187:drug effects; D019983:Guideline Adherence; D006787:Hospitals, Veterans / Q000592:standards; D006801:Humans; D033181:Information Dissemination; D007328:Insulin / Q000627:therapeutic use; D008297:Male; D008511:Medicine / Q000706:statistics & numerical data*; D009511:New England; D010044:Outpatient Clinics, Hospital / Q000592:standards / Q000706:statistics & numerical data; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care / Q000706:statistics & numerical data; D011647:Puerto Rico; D013038:Specialization; D013453:Sulfonylurea Compounds / Q000627:therapeutic use; D014481:United States; D014493:United States Department of Veterans Affairs
chemical_list: D006442:Glycated Hemoglobin; D007328:Insulin; D013453:Sulfonylurea Compounds