Impact of the diabetes Canada guideline dissemination strategy on dispensed vascular protective medications for older patients in Ontario, Canada: a linked EMR and administrative data study

Abstract

Background: The 2013 Diabetes Canada guidelines recommended routinely using vascular protective medications for most patients with diabetes. These medications included statins and angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs). Antiplatelet agents were only recommended for secondary prevention of cardiovascular disease. Using Electronic Medical Record (EMR) data, we previously found that guideline dissemination efforts were not associated with an increase in the rate of primary care prescriptions of these medications. However, this needs confirmation: patients can receive prescriptions from different sources including specialists and they may not always fill these prescriptions. Using both EMR and administrative health data, we examined whether guideline dissemination impacted the dispensing of vascular protective medications to patients. Methods: The study population included patients with diabetes aged 66 or over in Ontario, Canada. We created two cohorts using two different approaches: an Electronic Medical Record (EMR) algorithm for diabetes using linked EMRadministrative data and an administrative algorithm using population level administrative data. We examined data from January 2010 to December 2016. Patients with diabetes were deemed to be likely taking a medication (or covered) during a quarter if the daily amount for a dispensed medication would last for at least 75% of days in any given quarter. An interrupted time series analysis was used to assess the proportion of patients covered by each medication class. Proton pump inhibitors (PPIs) were used as a reference.

Impact of the publication of the Finnish Meds75+ database on the use of potentially inappropriate medications in older persons

“…More research has been reported about the impact of the publication of different clinical guidelines. 17,18 A study by Jang et al 19 is one of the few to evaluate the effects of nationwide PIM criteria on reducing PIM use in older persons in South Korea during 2013-2016. The authors used interrupted time series (ITS) analysis and found that the level of PIM prevalence decreased 0.49% at the patient level and 0.41% at the prescription level immediately after implementation of the drug utilization review (DUR), but that the trend in PIM use was unchanged.…”

“…Little is known about the trend changes in PIM use after implementation of PIM criteria at the national level. More research has been reported about the impact of the publication of different clinical guidelines 17,18 . A study by Jang et al 19 is one of the few to evaluate the effects of nationwide PIM criteria on reducing PIM use in older persons in South Korea during 2013‐2016.…”