Assessing variability in compliance with recommendations given by the International Diabetes Federation (IDF) for patients with type 2 diabetes in primary care using electronic records. The APNA study

Brugos-Larumbe, Antonio; Aldaz-Herce, Pablo; Guillén-Grima, Francisco; Garjón-Parra, Francisco Javier; Bartolomé-Resano, Francisco Javier; Arizaleta-Beloqui, María Teresa; Pérez-Ciordia, Ignacio; Navascués, Ana; Lerena-Rivas, María José; Berjón-Reyero, Jesús; Jusué-Rípodas, Luisa; Aguinaga-Ontoso, Inés

doi:10.1016/j.pcd.2017.06.008

Cited by 10 publications

(14 citation statements)

References 36 publications

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“…However, it is difficult to draw very strong conclusions about this because although the general practitioners followed good clinical care guidelines and monitored HbA 1 c -concentrations as recommended [ 13 – 15 ] there were other vital parameters which were not as well monitored during the follow-up. Marking T2D diagnosis on patient charts does not guarantee that T2D is properly treated [ 17 ] and neglecting actions which belong to proper T2D treatment is not uncommon in primary care [ 18 – 20 ]. We had difficulties in getting follow-up data about physical measurements such as weight and BP although these parameters may have prognostic value for T2D patients [ 21 ].…”

Section: Discussionmentioning

confidence: 99%

A longitudinal follow-up study of a type 2 diabetes “lost to follow-up” cohort – positive effect on glycaemic control after changes in medication

Kauppila

Laine

Honkasalo

et al. 2020

International Journal of Circumpolar Health

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The aim of this study was to evaluate whether patients with type 2 diabetes (T2D) who had stopped attending their diabetes treatment system (referred to as "lost to follow-up", LTF) but who succeeded in improving their glycaemic control after returning to the diabetes treatment system had changes in their diabetes medication when compared with similar patients who did not show improvement. "LTFs" who had baseline haemoglobin A 1 c (HbA 1 c) ≥53 mmol/mol and succeeded in reducing HbA 1 c ≥ 6 mmol/mol during a 12-30 month follow-up period after adhering again to their diabetes treatment system were compared with "LTFs" who had an unsatisfactory change in HbA 1 c or with "LTFs" who maintained good glycaemic control throughout the 12-30 month follow-up period. Unsatisfactory change in HbA 1 c was determined as HbA 1 c ≥ 53 mmol/mol and change <6 mmol/mol after the 12-30 month follow-up period in their diabetes treatment system or HbA 1 c < 53 mmol/mol when returning to the diabetes treatment system but ≥53 mmol/mol at the end of the 12-30 month follow-up period. "LTFs" with improvement in glycaemic control used a higher number of different anti-hyperglycaemic agents (P < 0.001) and their dosages of metformin increased (P < 0.05) when compared with "LTFs" without improvement or "LTFs" with satisfactory glycaemic control. Cholesterol-, LDL-cholesteroland triglyceride-concentrations decreased during the 12-30 month follow-up period (P < 0.05) in "LTFs" with improved glycaemic control, but not in the other groups. "LTFs" with T2D who had poor glycaemic control seemed to require an increase in their anti-diabetic medication when attempting to improve their glycaemic control.

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Section: Discussionmentioning

confidence: 99%

A longitudinal follow-up study of a type 2 diabetes “lost to follow-up” cohort – positive effect on glycaemic control after changes in medication

Kauppila

Laine

Honkasalo

et al. 2020

International Journal of Circumpolar Health

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“…Previous studies about variation among GPs in processes of care for type 2 diabetes patients [3,15,16], mostly report practice level factors only [8,9,26]. Studies on the GP level are primarily related to development of methods for "physician profiling" in the UK and the US [14][15][16], reporting performance of cost and quality rather than individual physician's characteristics.…”

Section: Comparison With Existing Literaturementioning

confidence: 99%

“…General practitioners are supposed to counsel patients in self-management and lifestyle modifications, monitor risk factors, screen for and treat complications, pursue individualized treatment targets and manage medications for hyperglycemia, hypertension and hyperlipidemia. A gap in the quality between the recommended and actual care for type 2 diabetes patients is well documented [1,2], as well as variations in quality within provider levels, regions and countries [3][4][5][6][7][8][9]. Some variation might reflect patient-centered care, whereas some variation is unwarranted and cannot be fully explained by disease severity or patient preferences [10].…”

Section: Introductionmentioning

confidence: 99%

Variation between general practitioners in type 2 diabetes processes of care

Nøkleby

Berg

Mdala

et al. 2021

Primary Care Diabetes

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Aims: To explore variation in general practitioners' (GPs') performance of six recommended procedures in type 2 diabetes patients <75 years without cardiovascular disease. Methods: Cross-sectional study of quality of diabetes care in Norway based on electronic health records from 2014. GPs (clustered in practices) were divided in quintiles based on a composite measure of performance of six processes of care. We fitted a multilevel partial ordinal regression model to identify GP factors associated with being in quintiles with better performance. Results: We identified 6015 type 2 diabetes patients from 275 GPs in 77 practices. The GPs performed on average 63.4% of the procedures; on average 46% in the poorest quintile to 81% in the best quintile with a larger range in individual GPs. After adjustments, use of a structured follow-up form was associated with GPs being in upper three quintiles (OR 12.4 (95% CI 2.37-65.1). Routines for reminders were associated with being in a better quintile . GPs' age >60 years and heavier workload were associated with poorer performance. Conclusion:We found large variations in GPs' performance of processes of care. Factors reflecting structure and workload were strongly associated with performance.

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“…The registry of Navarra was rated as the highest quality among the 17 Regional Health Services in Spain in patients with T2D [39]. In Navarra, studies have shown the usefulness of electronic records for assessing the quality of care of patients with T2D [7,[27][28][29]. This study could only access data on hospital admissions for cardiovascular CVE but not mortality data.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

“…Our study is part of a series of studies included under the acronym "APNA Study" (Navarra Primary Care Study) that analyze data from the computerized medical record registry of Navarra, with different purposes. Many studies are done with the data from this registry that endorse the data quality in terms of T2D [27][28][29][30].…”

Section: Introductionmentioning

confidence: 99%

Variability in the Control of Type 2 Diabetes in Primary Care and Its Association with Hospital Admissions for Vascular Events. The APNA Study.

Guillen-Aguinaga¹,

Forga²,

Brugos-Larumbe³

et al. 2021

Preprint

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Type 2 diabetes (T2D) is associated with increased cardiovascular morbidity, mortality, and hospital admissions. There is variability in clinical practice. The objectives are to analyze the variability in the control of Blood Pressure (BP), HbA1c, and LDL-C in T2D patients and its influence on admissions due to cardiovascular events (CVE) Methods: We analyzed the electronic records in Primary Care Health centers in Navarra (Spain) and hospital admission for CVE. We follow 480637 people from 2012 to 2016. We calculated indicators of control of patients with T2D for each year, percentage with: HbA1c &lt; 7%; HbA1c &gt;= 9%; BP &lt;140/90 mmHg; LDL-C &lt;100 mg/dl. We used logistic and Cox regression. Results: Patients in the best control GP practices cluster are 2.5 times more likely to have HbA1c &lt;7% [OR: 2.46 (95% CI: 2.29-3.64)]. Poor HbA1c control ≥ 9% is more likely in the worst control cluster [OR: 1.73 (95% CI:1.63-1.83)]. The probability of admission for CVE increases with age, being male, low income, obesity, history of CVE, having HbA1c ≥ 9%, and belonging to a GP practice in the cluster of HbA1C ≥ 9% worst control. In contrast, it decreases in patients with HbA1c &lt;7%, BP&lt;140/90 mmHg and LDL &lt;100 mg/dl.

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Assessing variability in compliance with recommendations given by the International Diabetes Federation (IDF) for patients with type 2 diabetes in primary care using electronic records. The APNA study

Cited by 10 publications

References 36 publications

A longitudinal follow-up study of a type 2 diabetes “lost to follow-up” cohort – positive effect on glycaemic control after changes in medication

A longitudinal follow-up study of a type 2 diabetes “lost to follow-up” cohort – positive effect on glycaemic control after changes in medication

Variation between general practitioners in type 2 diabetes processes of care

Variability in the Control of Type 2 Diabetes in Primary Care and Its Association with Hospital Admissions for Vascular Events. The APNA Study.

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