Are "Best Practices" Always Best?
December 6, 2001
A recent study found a 24 percent noncompliance rate in the use of best practice procedures by physicians treating patients with type 2 (or adult onset) diabetes, but researchers say this does not represent a deficiency in care but instead a deficiency in the definition of what constitutes best practices.
"Best practices" are generally recommended treatment protocols based on a consensus among physicians in a particular specialty and approved by a professional association. Advocates of adopting best practices claim it improves the quality of care, while some physicians see it as an attempt to limit their options in treating individual patients.
Researchers analyzed the treatment of 1,755 diabetics by 85 internists who volunteered for the study. Among the best practices recommended by the American Diabetes Association for type 2 diabetes patients are regular microalbuminuria screens, retinal exams and foot inspections.
- Many physicians questioned the usefulness of the microalbuminuria screen for patients who are already receiving angiotensin-converting enzyme inhibitors.
- Also, some patients did not receive eye exams because they were blind and there was no point to a retinal exam.
- In addition to conscious decisions by physicians, other instances of noncompliance included patient nonadherence, such as failing to modify diet or schedule appointments with an ophthalmologist or podiatrist as recommended; systems problems, such as lack of communication between doctors or reports not being distributed; and oversight or forgetfulness.
Researchers say that evidence-based best practice guidelines are often based on studies in which the subjects are younger and healthier, while the patients physicians actually see are older and sicker, and long-term preventative strategies may not be applicable to their immediate needs.
Source: Andis Robeznieks, "Study: Best Practices Not Always Best for All," American Medical News, December 3, 2001, American Medical Association; based on Christel Mottur-Pilson, Vincenza Snow and Kyle Bartlett, "Physician Explanations for Failing To Comply with 'Best Practices,'" Effective Clinical Practice, September/October 2001.
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