Is the Quality of Diabetes Care Better in a Diabetes Clinic or in a General Medicine Clinic?

Ho, Marion; Marger, Michael; Beart, Jenna; Yip, Ian; Shekelle, Paul G

doi:10.2337/diacare.20.4.472

Cited by 143 publications

(89 citation statements)

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“…CONCLUSIONS -Our finding of low levels of adherence by PCPs to a broad array of diabetes guidelines is consistent with findings by other researchers (2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17). Prior studies have demonstrated successful interventions to improve adherence to diabetes guidelines by PCPs.…”

Section: Analysessupporting

confidence: 80%

Impact of a Program to Improve Adherence to Diabetes Guidelines by Primary Care Physicians

et al. 2002

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OBJECTIVES -Previous studies have shown that primary care physician (PCP) adherence to diabetes guidelines is suboptimal. We sought to determine the state of diabetes care given by independently practicing PCPs in a rural county in Indiana and whether a multifaceted intervention targeting PCPs, patients, and the health care system would improve adherence to diabetes guidelines.RESEARCH DESIGN AND METHODS -Baseline audits to assess adherence to diabetes guidelines were done on charts of the seven PCPs in the county. Audits were repeated after development of local consensus guidelines and feedback of baseline performance and after implementation of various interventions (practice aids, physician detailing, patient education sessions, and implementation of computerized individual meal planning).RESULTS -Before any intervention, rates of adherence to guidelines were low (15% for foot exams, 20% for HbA 1c measurement, 23% for eye exam referrals, 33% for urine protein screening, 44% for lipid profiles, 73% for home glucose monitoring, and 78% for blood pressure measurements). One year after development of local consensus guidelines and feedback of baseline performance, significant improvements were seen in blood pressure measurements (71 vs. 83%; P ϭ 0.002), foot exams (19 vs. 42%; P Ͻ 0.001), HbA 1c measurements (26 vs. 37%; P ϭ 0.012), and PCP eye exams (38 vs. 46%; P ϭ 0.043); a trend toward improvement was seen in referral to eye specialists (25 vs. 33%; P ϭ 0.059). After a second year of multiple interventions, only blood pressure measurements (70 vs. 92%; P Ͻ 0.001) and foot exams (22 vs. 47%; P Ͻ 0.001) remained significantly improved; all other areas returned to rates indistinguishable from baseline.CONCLUSIONS -In busy primary care practices lacking organizational support and computerized tracking systems, sustained improvements in diabetes care are difficult to attain using traditional physician-targeted approaches.

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Section: Analysessupporting

confidence: 80%

Impact of a Program to Improve Adherence to Diabetes Guidelines by Primary Care Physicians

et al. 2002

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“…Aunque en la última década muchas organizaciones han medido la calidad de la atención a los pacientes diabéti-cos (20)(21)(22)(23)(24)(25), QUALIDIAB es el primer proyecto de medición de forma cooperativa y simultánea implementado en seis países de América Latina.…”

Section: Discussionunclassified

Evaluation of the quality of care for diabetic patients in Latin America

Gagliardino¹,

Hera²,

Siri³

2001

Rev Panam Salud Publica

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“…However, a large body of literature has suggested that patients with diabetes are not receiving appropriate care (10)(11)(12)(13). Efforts introduced by the National Committee for Quality Assurance (14) and the Diabetes Quality Improvement Project (15) to make health plans and medical groups more accountable for diabetes care have added pressure to address deficiencies in diabetes care.…”

Section: Pharmacy Datamentioning

confidence: 99%

Linking pharmacy and laboratory data to assess the appropriateness of care in patients with diabetes.

Wetzler

Snyder

2000

Diabetes Care

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OBJECTIVE -To use pharmacy and laboratory data to assess diabetes care within a medical group and between medical groups and to determine dispensing patterns and the extent to which providers change therapy based on HbA 1c results.RESEARCH DESIGN AND METHODS -Participating groups submitted 1 year of data for continuously enrolled patients. Required data included date of birth, all diabetes-specific prescriptions (oral hypoglycemic agents and insulin), date of prescription, National Drug Code, all HbA 1c values, lower and upper normal limits, and date of testing.RESULTS -Few changes in therapy were noted despite the large percentages of patients with suboptimal control. Nearly 90% of the patients treated with medications received a monotherapy regimen involving one of three therapeutic agents: sulfonylureas, metformin, or insulin. More than three-fourths of the patients remained on the same therapy during the observation period despite the fact that 27% of these patients had HbA 1c values Ն8%. Nearly onefifth (18%) of patients had an HbA 1c level of Ն8% and no further testing for at least 90 days after the "actionable" HbA 1c result was obtained. Furthermore, 54% of patients with actionable HbA 1c results did not have a change in therapy initiated after the result was available.CONCLUSIONS -The American Diabetes Association recommendations to act on HbA 1c values Ն8% and to follow up regularly on patients found to be in suboptimal control do not appear to be applied in a consistent manner based on the pharmacy and laboratory data analyzed in this sample.

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Is the Quality of Diabetes Care Better in a Diabetes Clinic or in a General Medicine Clinic?

Cited by 143 publications

References 0 publications

Impact of a Program to Improve Adherence to Diabetes Guidelines by Primary Care Physicians

Impact of a Program to Improve Adherence to Diabetes Guidelines by Primary Care Physicians

Evaluation of the quality of care for diabetic patients in Latin America

Linking pharmacy and laboratory data to assess the appropriateness of care in patients with diabetes.

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