Differences in the diagnosis and management of type 2 diabetes in 3 countries (US, UK, and Germany): results from a factorial experiment.
Differences in the diagnosis and management of type 2 diabetes in 3 countries (US, UK, and Germany): results from a factorial experiment.
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DOI：
10.1097/mlr.0b013e3181ca3ffc
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发表时间：
2010-04
期刊：
影响因子：
3
通讯作者：
McKinlay J
中科院分区：
文献类型：
--
作者：
von dem Knesebeck O;Gerstenberger E;Link C;Marceau L;Roland M;Campbell S;Siegrist J;de Cruppé W;McKinlay J
This paper examines the diagnosis and management of type-2 diabetes when exactly the same “patient” is encountered by 192 randomly selected primary care doctors in three different health care systems - the US, UK and Germany. We conducted a factorial experiment, employing two clinically authentic filmed scenarios, to examine country differences in the treatment of diabetes, while controlling for the effects of selected characteristics of patients and physicians. The “patient” in the first scenario presented with (undiagnosed) signs and symptoms strongly suggestive of diabetes, while the second scenario presented an already diagnosed “patient” with an emerging foot neuropathy. Physicians were asked how they would diagnose and manage the “patients” after watching the video vignettes using a questionnaire with standardised and open-ended questions. Regarding the first (undiagnosed) case, US doctors would ask significantly more questions than physicians from the UK and Germany (p<.001). German physicians would give less advice but would want to see the patient again much sooner (p<.001). Regarding the diagnosed case with an emerging foot neuropathy, US physicians would be most active in terms of questioning, testing, prescribing and advice giving. Again, physicians from Germany would be less active in terms of therapeutic strategies but they would like to see the patient again sooner (p=.005). Although physicians in the three countries encountered exactly the same “patient”, differences in diagnostic and management decisions were evident. The experimental design provides unconfounded estimates of health system differences while simultaneously controlling for the effects of selected patient attributes and physician characteristics.
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影响因子：
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通讯作者：
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