title: Coordinated primary and specialty care for type 2 diabetes mellitus, guidelines, and systems: an educational needs assessment.
abstract: OBJECTIVE
  To determine knowledge, competence, and attitudinal issues among primary care providers (PCPs) and diabetes specialists regarding the use and application of evidence-based clinical guidelines and the coordination of care between PCPs and diabetes specialists specifically related to referral practices for patients with diabetes.
  
  
  METHODS
  A survey tool was completed by 491 PCPs and 249 diabetes specialists. Data were collected from specialists online and from PCP attendees at live symposia across the United States. Results were analyzed for frequency of response and evaluation of significant relationships among the variables.
  
  
  RESULTS
  Suboptimal practice patterns and interprofessional communication as well as gaps in diabetes-related knowledge and processes were identified. PCPs reported a lack of clarity about who, PCP or specialist, should assume clinical responsibility for the management of diabetes after a specialty referral. PCPs were most likely to refer patients to diabetes specialists for management issues relating to insulin therapy and use of advanced treatment strategies, such as insulin pens and continuous glucose monitoring. A minority of PCPs and even fewer specialists reported the routine use of clinical guidelines in practice.
  
  
  CONCLUSIONS
  This research-based assessment identified critical educational needs and gaps related to coordinated care for patients with diabetes as well as the need for quality- and performance-based educational interventions.
authors.affiliation: Joslin Diabetes Center, Boston, Massachusetts 02215, USA. Richard.Beaser@joslin.harvard.edu
authors.forename: Richard S
authors.initials: RS
authors.lastname: Beaser
authors.forename: Eyiuche
authors.initials: E
authors.lastname: Okeke
authors.forename: James
authors.initials: J
authors.lastname: Neighbours
authors.forename: Julie
authors.initials: J
authors.lastname: Brown
authors.forename: Katie
authors.initials: K
authors.lastname: Ronk
authors.forename: Walter W
authors.initials: WW
authors.lastname: Wolyniec
mesh_terms: D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy / Q000628:therapy*; D004704:Endocrinology / Q000193:education*; D019317:Evidence-Based Medicine; D019538:Health Care Surveys; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D007328:Insulin / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D033183:Interdisciplinary Communication; D020407:Internet; D020380:Needs Assessment; D010819:Physician's Role; D058007:Physicians, Primary Care / Q000193:education*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D011361:Professional Competence; D012017:Referral and Consultation; D013038:Specialization; D014481:United States
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin