Intensive diabetes management: negotiating evidence-based practice.
OBJECTIVE
An exploration was completed of health professionals' experiences implementing evidence-based guidelines that promote intensive management (IM) for people with diabetes.


METHODS
In-depth, semi-structured interviews were conducted with 50 health professionals from across Canada. These professionals are considered to be opinion leaders in diabetes care. Interviews were audiotaped, transcribed verbatim, and coded with the assistance of NVivo software. Transcripts were analyzed using Potter and Wetherell's approach to discourse analysis.


RESULTS
Participants noted that recent clinical trials validated intensive approaches to diabetes management. While they viewed the evidence as sound, they did not feel that it justified IM approaches in all situations. Evidence-based practice therefore gave way to individual patient considerations. Implementing behavioural strategies, such as the stages of change model, allowed participants to modify their practices in ways that accommodated both evidence-based and patient-focused practice paradigms.


CONCLUSIONS
While evidence-based medicine influenced practice, it was only one discourse that shaped the way health professionals approached diabetes care.
Department of Nutritional Sciences and The Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
Ann
A
Fox
D000328:Adult; D001291:Attitude of Health Personnel; D002170:Canada; D002648:Child; D003920:Diabetes Mellitus / Q000628:therapy*; D055317:Evidence-Based Practice; D006801:Humans; D018802:Patient-Centered Care; D011364:Professional Practice