Management of diabetes in pediatric resident continuity clinics
K. K. Kronz, R. A. Hibbard, D. G. Marrero, G. M. Ingersoll, N. S. Fineberg and M. P. Golden
Department of Pediatrics, Indiana University School of Medicine, Indianapolis.
General pediatricians provide comprehensive care for many children with
insulin-dependent diabetes mellitus. To assess and improve our ambulatory
training program, we first evaluated diabetes-specific care behaviors by
residents in their continuity clinics and then introduced a structured
visit encounter form. Based on established guidelines provided to the
residents, a chart audit indicated appropriate measurement of glycosylated
hemoglobin 40% of the time, cholesterol 90% of the time, urine protein 50%
of the time, and thyroxine 66.7% of the time. Height was plotted 23% of the
time, blood pressure was noted 66% of the time, and ophthalmologic
referrals were documented 60% of the time. Requests for assistance from
nonphysician members of a multidisciplinary diabetes team were minimal.
After introduction of the structured visit encounter form, care behaviors
did not improve. New training approaches to prepare general pediatric
residents to provide excellent diabetes care are needed.
