title: Physicians' perceptions of barriers to cardiovascular disease risk factor control among patients with diabetes: results from the translating research into action for diabetes (TRIAD) study.
abstract: BACKGROUND
  Many patients with diabetes have poorly controlled blood glucose, lipid, or blood pressure levels, increasing their risk for cardiovascular disease (CVD) and other complications. Relatively little is known about what physicians perceive to be barriers to good CVD risk factor control or their own role in helping patients achieve good control.
  
  
  METHODS
  We interviewed 34 primary care physicians in 4 states to assess their perceptions of patients' barriers to CVD risk factor control. Interviews were coded and analyzed for emergent themes.
  
  
  RESULTS
  Physicians attributed barriers primarily to patients (socioeconomic issues, competing medical conditions, and lack of motivation) or to health system barriers (cost of care or lack of a multidisciplinary team). Physicians also expressed high levels of frustration with their efforts to address barriers.
  
  
  CONCLUSIONS
  Physicians felt that barriers to CVD risk factor control often were beyond their abilities to address. Training physicians or other members of the primary health care team to address patients' personal barriers and health system barriers to good control could help alleviate high frustration levels, improve relationships with patients, and improve the treatment of diabetes. Supporting such efforts with adequate reimbursement should be a focus of health care reform.
authors.affiliation: Research Division, Department of Family Medicine, University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School, Somerset, NJ 08873, USA. jesse.crosson@umdnj.edu
authors.forename: Jesse C
authors.initials: JC
authors.lastname: Crosson
authors.forename: Michele
authors.initials: M
authors.lastname: Heisler
authors.forename: Usha
authors.initials: U
authors.lastname: Subramanian
authors.forename: Bix
authors.initials: B
authors.lastname: Swain
authors.forename: Gabrielle J
authors.initials: GJ
authors.lastname: Davis
authors.forename: Norman
authors.initials: N
authors.lastname: Lasser
authors.forename: Sonja
authors.initials: S
authors.lastname: Ross
authors.forename: Julie A
authors.initials: JA
authors.lastname: Schmittdiel
authors.forename: Kingsley
authors.initials: K
authors.lastname: Onyemere
authors.forename: Chien-Wen
authors.initials: CW
authors.lastname: Tseng
mesh_terms: D001291:Attitude of Health Personnel; D002318:Cardiovascular Diseases / Q000517:prevention & control* / Q000523:psychology*; D003299:Cooperative Behavior; D003925:Diabetic Angiopathies / Q000517:prevention & control* / Q000523:psychology*; D005639:Frustration; D015438:Health Behavior; D006297:Health Services Accessibility; D006302:Health Services Research; D006801:Humans; D008019:Life Style; D008329:Managed Care Programs; D010348:Patient Care Team; D010349:Patient Compliance / Q000523:psychology*; D010819:Physician's Role / Q000523:psychology*; D010817:Physician-Patient Relations; D011320:Primary Health Care; D011785:Quality Assurance, Health Care; D012307:Risk Factors; D014481:United States