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Deficiencies in the quality of diabetes care: comparing specialist with generalist care misses the point

Shah BR, Hux JE, Laupacis A, Zinman B, Zwarenstein M. J Gen Intern Med. 2007; 22(2):275-9.


The quality of diabetes care delivered to patients falls below the expectations of practice guidelines and clinical trial evidence. Studies in many jurisdictions with varying health care systems have shown that recommended processes of care occur less often than they should; hence, outcomes of care are inadequate. Many studies comparing care between specialists and generalists have found that specialists are more likely to implement processes of care. However, this provides little insight into improving quality of care, as the difference between specialists and generalists in these studies is small compared to the overall deficiency in quality.

Therefore, future research should instead focus on ways to implement high quality care, regardless of specialty. To date, few methodologically rigorous studies have uncovered interventions that can improve quality of care. The development of such interventions to help all physicians implement better quality care could greatly benefit people with diabetes.

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Keywords: Quality indicators Primary care/clinical practice Diabetes

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