Table 4.
Physician perspectives on diabetes prevention: themes and illustrative quotes.
| Theme 1. System-level barriers to screening and treatment |
| Provider 16: Nowadays, ‘cause most people don’t come in fasting, if they’re – This is gonna sound terrible. If they’re non-Medicare then I can get hemoglobin A1C.[…] unfortunately if they’re Medicare, Medicare won’t pay for hemoglobin A1C, so I have to ask them to come back fasting so that I can kind of get a fasting glucose Provider 1: The available resources vary so tremendously from provider or from insurance to insurance […] that makes implementation hard. |
| Theme 2. Race and gender implicit bias concerns |
| Provider 3: Obviously I probably have unconscious biases […]. I’m trying to think actually demographically if I have noticed a difference in my patient population between various races and diabetes.[…] |
| Provider 18: I mean I think it may be more prevalent in women but I’m not even sure about that. I mean I think I look at it – I’m not sure that I have a gender bias when it comes to making that decision. |
| Theme 3. Patient-level factors affecting screening and treatment decisions |
| Provider 8: Well, there are a lot of variables, including access to care, money, time, availability, knowing the patients, so I know a lot of my patients, so I know what they’re gonna say, almost. So yeah, so if someone has limitations in financing or coming in because they don’t want to miss work then I usually give them some counseling here in person |
| Provider 20: […]I think that if you were talking with primary care providers, most of us would say that we just are limited a lot in our time that we have with patients, and so yes, it would be wonderful to be able to block off 40 min to talk to them about diet and nutrition and carb counting and glucose checks |
| Theme 4. PCP preference for initial treatment |
| Provider 10: We usually just talk about lifestyle modifications. I rarely have ever put someone on something like metformin. |