Impact of the Diabetes Canada Guideline Dissemination Strategy on the Prescription of Vascular Protective Medications: A Retrospective Cohort Study, 2010–2015

Abstract

The 2013 Diabetes Canada guidelines launched targeted dissemination tools and a simple assessment for vascular protection. We aimed to 1) examine changes associated with the launch of the 2013 guidelines and additional dissemination efforts in the rates of vascular protective medications prescribed in primary care for older patients with diabetes and 2) examine differences in the rates of prescriptions of vascular protective medications by patient and provider characteristics. RESEARCH DESIGN AND METHODS The study population included patients (‡40 years of age) from the Canadian Primary Care Sentinel Surveillance Network (CPCSSN) with type 2 diabetes and at least one clinic visit from April 2010 to December 2015. An interrupted time series analysis was used to assess the proportion of eligible patients prescribed a statin, ACE inhibitor (ACEI)/angiotensin receptor blocker (ARB), or antiplatelet prescription in each quarter. Proton pump inhibitor (PPI) prescriptions were the reference control. RESULTS A dynamic cohort was used where participants were enrolled each quarter using a prespecified set of conditions (range 25,985-70,693 per quarter). There were no significant changes in statin (P = 0.43), ACEI/ARB (P = 0.42), antiplatelet (P = 0.39), or PPI (P = 0.16) prescriptions at baseline (guideline intervention). After guideline publication, there was a significant change in slope for statin (20.52% per quarter, SE 0.15, P < 0.05), ACEI/ARB (20.38% per quarter, SE 0.13, P < 0.05), and reference PPI (20.18% per quarter, SE 0.05, P < 0.05) prescriptions. CONCLUSIONS There was a decrease in prescribing trends over time that was not specific to vascular protective medications. More effective knowledge translation strategies are needed to improve vascular protection in diabetes in order for patients to receive the most effective interventions.

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

“…We found no improvements in the trend for rates of prescriptions [8]. While the EMR provides information on whether a patient was given a prescription by their primary care provider, it may not provide complete information on whether a patient has filled the prescription or is likely taking the medication (coverage rate).…”

“…Our previous study evaluated the 2013 Diabetes Canada guidelines impact on vascular protective prescriptions using EMR data from CPCSSN, which had limitations in its ability to capture medication coverage, medications prescribed outside of primary care, and duration of prescription given variation in refill protocols [8]. Using administrative data has helped to mitigate these concerns and validate previous findings, which revealed no increase in the rates of statin or ACEi/ARB prescriptions after guideline implementation.…”

“…As well, data on the duration of each prescription may be incompletely captured: a medication may be prescribed with several refills that may not be completely captured due to the structure of the EMR. Our previous guideline evaluation used a lag-lead approach to account for such variations in refill protocol and prescription procedures among family physicians [8]. Validating our results using different sources of information under different assumptions is important.…”

The Impact of Treatment Adherence for Patients With Diabetes and Hypertension on Cardiovascular Disease Risk: Protocol for a Retrospective Cohort Study, 2008-2018

“…We will use this approach to account for the variation in refills. Based on a study using the CPCSSN database, we assume that patients adhered to medications if they had any prescription record in the 4 preceding quarters and 1 quarter after each quarter of interest (lag4, lead1) [64].…”

Effective web-based clinical practice guidelines resources: recommendations from a mixed methods usability study

“…We performed a mixed methods usability study of the Diabetes Canada (DC) CPG website, a comprehensive CPG website with a wide reach to both clinicians and the general public [10][11][12][13][14]. Usability testing has been widely used to assess and improve health technologies including websites [12].…”