I think there is a good reason why some physicians are current on guidelines and newer drug therapies and others seem to lag behind. This reason has more to do with the insurance plans that they take than a lack of desire to treat patients with the best care. Although we run articles on accountability and quality of care the truth is that many practitioners prescribe by formulary rather than guidelines.
I recently did a diabetes class for an office that had a large group of patients enrolled in a low cost, low reimbursement plan. As I was discussing the program in advance, the prescriber made the comment that the majority of her patients had very poor formulary coverage and that she often did not discuss the most current guidelines due to her patient demographics. This goes hand in hand with a diabetes drug talk I did at a large clinic practice where a couple of the physicians mentioned that they did not really know anything about GLP-1 analog therapy because none of their patients had coverage for it.
It seems to me if we want all clinicians to have the same knowledge base then they are going to have to have the same access to medications for their patients.
Dave Joffe, Editor-in-chief