Thwarted doctors blame diabetic patients, poverty for lack of care


POSTED: Monday, March 29, 2010

Doctors are expressing frustration that they cannot keep many diabetic patients from developing potentially deadly cardiovascular disease, and blame a variety of factors, including the patients themselves.

A first-of-its-kind study, which sought opinions from 34 primary care physicians in four mainland states, found that some feel that many patients lack the money or the motivation to get proper care. Some fault the costs of health care.

“;They were extremely frustrated and feeling like none of it was under their control, that they had run out of options on what they could do to help patients,”; said Dr. Chien-Wen Tseng, a Hawaii researcher and senior author of the study, published online last week by the Journal of the American Board of Family Medicine. “;Multiply that by all the general internists and physicians across the country. Is this a bigger problem we need to address?”;

; The researchers point out that heart disease death rates for adults with diabetes are two to four times higher than adults without diabetes. About 8 percent of Americans have diabetes, a disease marked by high levels of sugar in the blood.

Tseng, in an interview, said other studies have linked poor diabetes outcomes to lack of insurance, financial and transportation difficulties, other medical conditions and family problems.

“;We had never actually asked physicians what they perceived barriers to be,”; said Tseng, a family physician and investigator at the Pacific Health Research Institute.

Interviewed for the study were physicians who provide outpatient care to adult diabetic patients as part of a 10-year project called Translating Research into Action for Diabetes.

They cited significant socioeconomic barriers to good diabetic health, such as the high cost of transportation to get to appointments and the high cost of medication and healthful food. Family-related concerns and other medical conditions also hamper patient efforts to control cardiovascular risk factors, they said.

“;Certain things were not a surprise, such as patients having monetary barriers,”; said Tseng, associate director of research at the University of Hawaii John A. Burns School of Medicine.

But the attitude of physicians interviewed in California, Indiana, Michigan and New Jersey “;was a shock,”; said Tseng. “;None said, 'This was my fault.'”;

Tseng said the next study will look at how a doctor's frustration affects treatment.

“;If I had diabetes and it was not well controlled, I would want to go to a physician trying to help me and not giving up on me,”; she said.

She said the research team will look at clinical tools to help physicians motivate and communicate with patients.

The U.S. Centers for Disease Control and Prevention and National Institute of Diabetes and Digestive and Kidney Diseases are funding the TRIAD project at six sites, including the Pacific Health Research Institute, to understand and improve care for patients with diabetes in managed care settings.