A total of 175 visits were directly observed in 18 different clinics.

1. Content of Primary Care Visits by Adults with Type 2 Diabetes A STARNet Study Michael L. Parchman, MD, MPH; Jacqueline A. Pugh, MD; Raquel Romero, MD Selected Results Background and Methods • Problem:Although over 80% of all physician visits by adults with type 2 diabetes are to primary care physicians, little is known about the content of those visits, what diabetes-specific services are provided, and the number of issues addressed. • Participants:Direct observation of visits by 8-10 adult patients with type 2 diabetes in 18 different primary care offices. • Data Collection: A trained observer was present in the exam room for each visit and recorded number of topics discussed, length of the visit, number of prescriptions refilled, number of diabetes-specific services accomplished and number of physical exam items done. • Outcome Measure: Delivery of an indicated diabetes-related service was counted as ‘yes’ if any of the following five services had not been done in the past 12 months and were performed during the observed visit: a foot exam, a referral for an eye exam, a HbA1c, lipid profile or micro-albumin test; or if diet was discussed during the visit. Figure 1 Figure 2 Results • A total of 175 visits were directly observed in 18 different clinics. • The mean number of additional chronic illnesses per patient was 4.6 (SD 2.3) • The mean number of chronic medications per patient was 6.4 (SD 3.1) • A mean of 2.2 (S.D. 1.8) medication prescriptions were provided during the visit. • In 25% of all visits there was a change in medications. • The mean length of each visit was 17.5 (S.D. 9.1) minutes. • An average of 15.5 (S.D. 7.7) topics were discussed per visit, for an average of 1.1 minutes per topic. • 71% of all patients presented with an acute complaint. (Figure 1) • Out of 10 possible physical exam items, a mean of 4.3(S.D. 2.7) were performed per visit. • The percent delivery of each indicated diabetes service is shown in Figure 2. • As the number of topics discussed increased, so did the mean length of visit(r = 0.56, p<.001) (Figure 3)). • Visits with delivery of all indicated diabetes services were significantly longer than visits where less than all services were delivered. (t-test = 2.90, p < .05) (Figure 4) Figure 4 Figure 3 Conclusions • Visits by adult patients with type 2 diabetes to primary care physicians are complex and demanding. • Prior studies in primary care settings have found that multiple competing demands during the physician-patient encounter force clinicians to prioritize those demands and only deal with the most pressing or symptomatic problem. • A similar phenomenon may limit the delivery of indicated diabetes related services in this setting. • Interventions designed to improve the quality of diabetes care in primary care practices should take into account the complex competing demands within the primary care office encounter. Acknowledgement: Funding for this study was provided by AHRQ, Grant # K08 HS013008-02; HRSA Grant # 5D12HP00008-02; the Department of Veteran Affairs, HSR&D; and the South Texas Health Research Center. Special thanks to the physicians and staff of the South Texas Ambulatory Research Network. (STARNet) Contact email: parchman@uthscsa.edu