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Differential Adoption of Pharmacotherapy Recommendations for Type 2 Diabetes by Generalists and Specialists

Center for Health Quality, Outcomes, and Economic Research

Jennifer Anderson

Center for Health Quality, Outcomes, and Economic Research, and Boston University School of Medicine

Leonard M. Pogach

VA New Jersey Health Care System, and University of Medicine and Dentistry of New Jersey/New Jersey Medical School

Dan R. Berlowitz

Center for Health Quality, Outcomes, and Economic Research, and Department of Health Services, Boston University School of Public Health

Newer, multimedication (novel) regimens provide better glycemic control for many type 2 diabetics when sulfonylurea monotherapy (traditional) becomes ineffective. Because better glycemic control is associated with decreased likelihood of complications and lower utilization and cost of care, the authors examined change in prescribing patterns for veterans with type 2 diabetes between FY 97 and 99. They classified medication regimens as traditional and novel based on the combination of diabetes medications patients received at the end of each year. Multivariate logistic regression analyses controlling for disease severity indicated that patients were more likely to receive novel regimens over time, but those seen only in primary care were less likely to receive novel regimens than those previously seen by a specialist. Geographic differences and differences in how recommendations were implemented by generalists and specialists suggest that diffusion of innovations theory may help explain variations in practice and guide interventions designed to translate research into practice.

Key Words: adoption • diffusion • diabetes • pharmacotherapy • specialty differences • primary care

Medical Care Research and Review, Vol. 60, No. 2, 178-200 (2003)
DOI: 10.1177/1077558703060002003


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