Anne C. Larme|Jacqueline A. Pugh
Evidence-Based Guidelines Meet the Real World
The University of Texas Health Science Center at San Antonio|The University of Texas Health Science Center at San Antonio
improving diabetes care us critical diabetes rates increasing dramatically particularly among minority lowincome populations although evidencebased practice guidelines diabetes widely disseminated many physicians fail implement objective study explore happens diabetes practice guidelines realworld clinical settingsa qualitative research design used openended semistructured interviews lasting 12 h conducted 32 key informants physicians certified diabetes educators researchers agency personnel selected knowledge diabetes care south texas area high diabetes prevalence large proportion minority lowincome patientshealth professionals stress contextual factors important barriers optimal diabetes care physician knowledge attitudes barriers exist multiple levels interrelated complex manner examples include following time constraints practice economics private practice setting need maintain referral relationships maldistribution professionals practice community low awareness low socioeconomic status among patients lack access lowincome patients low reimbursement insufficient focus prevention us health care systemcontextual barriers must addressed order diabetes practice guidelines implemented realworld clinical practice suggested changes include increased focus prevention improvements health care delivery chronic diseases increased attention special needs minority lowincome populations