title: Challenges and opportunities for implementing diabetes self-management guidelines.
abstract: OBJECTIVE
  The purpose of this article was to examine primary care providers' perceived challenges when implementing evidence-based diabetes self-management guidelines and opportunities for promoting the use of such guidelines in practice.
  
  
  METHODS
  We engaged 3 group discussions with 43 key stakeholders representing family physicians, medical directors, and quality assurance leaders in a large, university-affiliated, integrated health care organization in Central Texas. Transcripts from group discussions were summarized using thematic content analysis.
  
  
  RESULTS
  Key themes that emerged as challenges of implementing evidence-based diabetes self-management guidelines included lack of easily retrievable electronic patient health information, inadequate coordination with other health care providers when implementing guidelines, conflict between information in the guidelines and physicians' knowledge, and physician compensation by patient load rather than by quality of care. Two main opportunities identified were the use of health coaches or nurses trained in diabetes self-management and active collaboration between practicing providers and key stakeholders in the development and dissemination of guidelines.
  
  
  CONCLUSIONS
  Our study shows a need for involving front-line family physicians and other primary care providers as well as patients in the design and development of best practice guidelines to enhance implementation of diabetes self-management guidelines in primary care settings.
authors.affiliation: Department of Health Promotion and Community Health Sciences, School of Rural Public Health, Texas A&M Health Science Center, College Station, TX, USA.
authors.forename: Bernard
authors.initials: B
authors.lastname: Appiah
authors.forename: Yan
authors.initials: Y
authors.lastname: Hong
authors.forename: Marcia G
authors.initials: MG
authors.lastname: Ory
authors.forename: Janet W
authors.initials: JW
authors.lastname: Helduser
authors.forename: Dawn
authors.initials: D
authors.lastname: Begaye
authors.forename: Jane N
authors.initials: JN
authors.lastname: Bolin
authors.forename: Samuel N
authors.initials: SN
authors.lastname: Forjuoh
mesh_terms: D001291:Attitude of Health Personnel; D003299:Cooperative Behavior; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration*; D003920:Diabetes Mellitus / Q000628:therapy*; D005194:Family Practice; D006126:Group Processes; D006284:Health Plan Implementation / Q000458:organization & administration*; D006801:Humans; D017410:Practice Guidelines as Topic; D011320:Primary Health Care / Q000458:organization & administration*; D012648:Self Care; D013781:Texas