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

Wetzler, Harry P.; Snyder, James W.

doi:10.2337/diacare.23.11.1637

Cited by 38 publications

(41 citation statements)

References 15 publications

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“…This analysis was performed for selected agents. Secondary failure was defined as a patient adding one or more concomitant OHAs and/or switching from the initial OHA to a different agent (12,13). Finally, therapy change was defined as a combined utilization metric that included therapy augmentation, dosage adjustments (up or down), or switching to another OHA.…”

Section: Study Definitionsmentioning

confidence: 99%

“…Another study by Wetzler and Snyder (13) described suboptimal control of type 2 diabetes with a monotherapeutic approach, showing that 27% of patients remained on the same monotherapy agent, even though they failed to achieve an HbA 1c level Ͻ8%. Another important aspect of this study was the evaluation of the mechanism and time to OHA therapy failure.…”

Section: Study Definitionsmentioning

confidence: 99%

See 1 more Smart Citation

Utilization of Oral Hypoglycemic Agents in a Drug-Insured U.S. Population

Boccuzzi¹,

Wogen²,

Fox³

et al. 2001

Diabetes Care

165

101

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OBJECTIVE -Clinical trials provide information regarding the safety and efficacy of medications used to manage type 2 diabetes but do not elucidate drug effectiveness in a typical managed care environment. The aim of this study was to characterize "real-world" drug utilization patterns from both a prescriber and a patient perspective.RESEARCH DESIGN AND METHODS -We conducted a retrospective analysis of a large administrative pharmacy claims database, using data on continuously pharmacy benefiteligible members prescribed oral hypoglycemic agents (OHAs).RESULTS -The 12-month persistence rate for the OHA cohort was low, ranging from 31% for ␣-glucosidase inhibitors to 60% for metformin; compliance rates varied between 70 and 80%. During the first 12 months of therapy, 36% of the patients remaining on therapy at 12 months had one or more therapy modifications. The mean number of therapy changes increased with the length of patient follow-up, with more than half of all patients experiencing at least one therapy change over the duration of follow-up.CONCLUSIONS -These findings document the wide variation in utilization patterns associated with pharmacological management of type 2 diabetes, suggesting that opportunity exists to optimize its pharmacological management.

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Section: Study Definitionsmentioning

confidence: 99%

Section: Study Definitionsmentioning

confidence: 99%

Utilization of Oral Hypoglycemic Agents in a Drug-Insured U.S. Population

Boccuzzi¹,

Wogen²,

Fox³

et al. 2001

Diabetes Care

165

101

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“…Our study builds on the work of others (5,20) who have pointed to clinical inertia as a key barrier to effective diabetes management. Prior studies have identified several factors that are correlated with greater medication intensification, including absolute level of A1C (2,4) and systematic features of the clinical practice Our results must be interpreted in the context of the study design.…”

Section: Multivariate Modelsmentioning

confidence: 99%

Relationship Between Patient Medication Adherence and Subsequent Clinical Inertia in Type 2 Diabetes Glycemic Management

et al. 2007

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OBJECTIVE -Clinical inertia has been identified as a critical barrier to glycemic control in type 2 diabetes. We assessed the relationship between patients' initial medication adherence and subsequent regimen intensification among patients with persistently elevated A1C levels.RESEARCH DESIGN AND METHODS -We analyzed an inception cohort of 2,065 insured patients with type 2 diabetes who were newly started on hypoglycemic therapy and were followed for at least 3 years between 1992 and 2001. Medication adherence was assessed by taking the ratio of medication days dispensed (from pharmacy records) to medication days prescribed (as documented in the medical record) for the first prescribed hypoglycemic drug. Adherence was measured for the period between medication initiation and the next elevated A1C result measured at least 3 months later; intensification was defined as a dose increase or the addition of a second hypoglycemic agent.RESULTS -Patients were aged (mean Ϯ SD) 55.4 Ϯ 12.2 years; 53% were men, and 19% were black. Baseline medication adherence was 79.8 Ϯ 19.3%. Patients in the lowest quartile of adherence were significantly less likely to have their regimens increased within 12 months of their first elevated A1C compared with patients in the highest quartile (27 vs. 37%, respectively, with increased regimens if A1C is elevated, P Ͻ 0.001). In multivariate models adjusting for patient demographic and treatment factors, patients in the highest adherence quartile had 53% greater odds of medication intensification after an elevated A1C (95% CI 1.11-1.93, P ϭ 0.01). CONCLUSIONS

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“…The other selected indicators were sequential indicators that incorporate different levels of the longitudinal aspect of patient care, as identified in other studies looking at the evaluation of appropriate care. 14,15,21,26 Table 1 describes for each indicator the patients included in the numerator and denominator.…”

Section: Data Collection and Quality Indicatorsmentioning

confidence: 99%

Cross-Sectional Versus Sequential Quality Indicators of Risk Factor Management in Patients with Type 2 Diabetes

Voorham¹,

Denig²,

Wolffenbuttel³

et al. 2008

Medical Care

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Cross-sectional versus sequential quality indicators of risk factor management in patients with type 2 diabetes Voorham, Jaco; Denig, Petra; Wolffenbuttel, Bruce H. R.; Haaijer-Ruskamp, Flora M. CopyrightOther than for strictly personal use, it is not permitted to download or to forward/distribute the text or part of it without the consent of the author(s) and/or copyright holder(s), unless the work is under an open content license (like Creative Commons).Take-down policy If you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediately and investigate your claim.Downloaded from the University of Groningen/UMCG research database (Pure): http://www.rug.nl/research/portal. For technical reasons the number of authors shown on this cover page is limited to 10 maximum. Results: According to the reference method, 76% of the patients received management as recommended for glycemic control, 58% for blood pressure control, and 67% for lipid control. Cross-sectional indicators looking at patients adequately controlled gave estimates that were 10 -25% lower than the reference method.Estimates from indicators focusing on uncontrolled patients receiving treatment were 10 -40% higher than the reference method for blood pressure and glycemic control. Sequential indicators focusing on improvement in clinical outcomes or assessing treatment modifications in response to poor control gave results closer to the reference method. Conclusions: Sequential indicators are valuable for estimating quality of risk factor management in patients with diabetes. Such indicators may provide a more accurate and fair judgment than currently used cross-sectional indicators.Key Words: quality indicators health care, diabetes mellitus, quality of health care, outcome and process assessment (health care) (Med Care 2008;46: 133-141) Q uality of diabetes care has received a lot of attention over the past decade, and room for improvement of glycemic, blood pressure, and lipid management has repeatedly been shown. [1][2][3][4][5][6] There is, however, debate about the fairness of indicators used to assess quality of care, especially for external accountability. [7][8][9][10] Many studies looking at quality of care use a cross-sectional approach where processes and outcomes of care are measured at one point in time. [2][3][4][5][6][11][12][13] This approach may be limited, because it does not take the longitudinal nature of chronic patient care into account. One study showed that, although quality of care may seem to improve over time using cross-sectional assessments, a longitudinal approach can show that specific patient groups are not benefiting.9 There are also discrepancies between indicators based on process and outcome measures. It has been shown that only looking at outcomes of care can result in an inaccurate view.14,15 Such indicators do not differentiate between patients receiving suboptimal care and patients that are difficult to manage or noncompliant. Therefore, th...

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

Cited by 38 publications

References 15 publications

Utilization of Oral Hypoglycemic Agents in a Drug-Insured U.S. Population

Utilization of Oral Hypoglycemic Agents in a Drug-Insured U.S. Population

Relationship Between Patient Medication Adherence and Subsequent Clinical Inertia in Type 2 Diabetes Glycemic Management

Cross-Sectional Versus Sequential Quality Indicators of Risk Factor Management in Patients with Type 2 Diabetes

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