Glycaemic, blood pressure and lipid goal attainment and chronic kidney disease stage of type 2 diabetic patients treated in primary care practices

Corcillo, Antonella; Pivin, Edward; Lalubin, Fabrice; Pitteloud, Nelly; Burnier, Michel; Zanchi, Anne

doi:10.4414/smw.2017.14459

Cited by 5 publications

(4 citation statements)

References 40 publications

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“…We found no substantial effect from GP and practice characteristics on QI performance, whereas several patient characteristics had a small effect. The patient population included in our study is highly comparable to the patient population of a recent RCT and a cross-sectional study in Swiss primary care [25,26] in terms of age, gender, comorbidities and consultation count. In terms of age and gender, our study population was also highly comparable to other European diabetes populations, whereas in terms of comorbidities our population had less micro-and macro-vascular diseases [27].…”

Section: Discussionmentioning

confidence: 91%

Quality performance and associated factors in Swiss diabetes care – A cross-sectional study

et al. 2020

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Data Availability Statement: The data was gathered within the ongoing FIRE project. The FIRE database can be accessed at any time by the scientific team of the institute. Legal restrictions in Switzerland prohibit public release of original Conclusion The influence of practice, general practitioner and patient characteristics on quality indicator performance was surprisingly small and room for improvement in quality indicator performance of Swiss general practitioners seems to exist in diabetes care.

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Section: Discussionmentioning

confidence: 91%

Quality performance and associated factors in Swiss diabetes care – A cross-sectional study

et al. 2020

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“…This study thus closes a gap, left by observational studies. Moreover, the baseline analysis showed that the patient population in this trial was highly comparable to other diabetes populations in Swiss primary care (22)(23)(24).…”

Section: Strengths and Limitations Of This Studymentioning

confidence: 80%

Long-Term Effects of Financial Incentives for General Practitioners on Quality Indicators in the Treatment of Patients With Diabetes Mellitus in Primary Care—A Follow-Up Analysis of a Cluster Randomized Parallel Controlled Trial

et al. 2021

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Background: The effect of financial incentives on the quality of primary care is of high interest, and so is its sustainability after financial incentives are withdrawn.Objective: To assess both long-term effects and sustainability of financial incentives for general practitioners (GPs) in the treatment of patients with diabetes mellitus based on quality indicators (QIs) calculated from routine data from electronic medical records.Design/Participants: Randomized controlled trial using routine data from electronic medical records of patients with diabetes mellitus of Swiss GPs.Intervention: During the study period of 24 months, all GPs received bimonthly feedback reports with information on their actual treatment as reflected in QIs. In the intervention group, the reports were combined with financial incentives for quality improvement. The incentive was stopped after 12 months.Measurements: Proportion of patients meeting the process QI of annual HbA1c measurements and the clinical QI of blood pressure levels below 140/85 mmHg.Results: A total of 71 GPs from 43 different practices were included along with 3,854 of their patients with diabetes mellitus. Throughout the study, the proportion of patients with annual HbA1c measurements was stable in the intervention group (78.8–78.9%) and decreased slightly in the control group (81.5–80.2%) [odds ratio (OR): 1.21; 95% CI: 1.04–1.42, p < 0.05]. The proportion of patients achieving blood pressure levels below 140/85 mmHg decreased in the control group (51.2–47.2%) and increased in the intervention group (49.7–51.9%) (OR: 1.18; 95% CI: 1.04–1.35, p < 0.05) where it peaked at 54.9% after 18 months and decreased steadily over the last 6 months.Conclusion: After the withdrawal of financial incentives for the GPs after 12 months, some QIs still improved, indicating that 1 year might be too short to observe the full effect of such interventions. The decrease in QI achievement rates after 18 months suggests that the positive effects of time-limited financial incentives eventually wane.

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“…Duration of diabetes is an independent risk factor for the development and progression of renal impairment 33 and patients who receive their T2DM care in a primary care setting tend to have a shorter diabetes duration and/or less established diabetes-related complications as compared with outpatients in tertiary care. 34 However, considering that CKD often remains undiagnosed until a progressive stage has already been established, early detection is paramount. A considerable variation in consistency of renal function assessment in patients at risk in general practices in Switzerland has been shown, 35 indicating a need to improve awareness of the importance of CKD detection and treatment among all levels of healthcare.…”

Section: Discussionmentioning

confidence: 99%

Assessing the use of sodium-glucose cotransporter 2 inhibitor in patients with type 2 diabetes mellitus and chronic kidney disease in tertiary care: a SwissDiab Study

Hösli,

Renström,

Laimer

et al. 2024

BMJ Open Diab Res Care

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Introduction The overall aim of this study was to evaluate the implementation of sodium-glucose cotransporter 2 inhibitors (SGLT2i) among patients in tertiary care with type 2 diabetes mellitus (T2DM) and chronic kidney disease (CKD). Research design and methods The cross-sectional analysis was based on outpatients in tertiary diabetes care enrolled in the Swiss Diabetes Registry with T2DM and a study visit January 1, 2020–March 31, 2021. Prevalence of CKD was ascertained as an estimated glomerular filtration rate <60 mL/min/1.73 m 2 and/or persistent albuminuria as defined by Kidney Disease Improving Global Outcomes, and the proportion of patients prescribed SGLT2i was determined. Documented reasons for non-treatment with SGLT2i were extracted by a retrospective review of the medical records. Results Of 368 patients with T2DM, 1.1% (n=4) were excluded due to missing data. Of the remaining 364 patients, 47.3% (n=172) had CKD of which 32.6% (n=56) were prescribed SGLT2i. The majority (75%) of these patients were on treatment already in 2018, before the renoprotective effects of SGLT2i were established. Among the 116 patients without SGLT2i, 19.0% had known contraindications, 9.5% stopped treatment due to adverse events, 5.2% had other reasons, and no underlying reason for non-treatment could be identified for 66.4%. Conclusions A divergence between recommended standard of care and implementation in daily clinical practice was observed. Although treatment should always consider patient-specific circumstances, the results highlight the need to reinforce current treatment recommendations to ensure patients benefit from the best available care.

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Glycaemic, blood pressure and lipid goal attainment and chronic kidney disease stage of type 2 diabetic patients treated in primary care practices

Cited by 5 publications

References 40 publications

Quality performance and associated factors in Swiss diabetes care – A cross-sectional study

Quality performance and associated factors in Swiss diabetes care – A cross-sectional study

Long-Term Effects of Financial Incentives for General Practitioners on Quality Indicators in the Treatment of Patients With Diabetes Mellitus in Primary Care—A Follow-Up Analysis of a Cluster Randomized Parallel Controlled Trial

Assessing the use of sodium-glucose cotransporter 2 inhibitor in patients with type 2 diabetes mellitus and chronic kidney disease in tertiary care: a SwissDiab Study

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