Membership in a diabetes-care network and adherence to clinical practice guidelines for treating type 2 diabetes among general practitioners: A four-year follow-up

Casanova, Ludovic; Bocquier, Aurélie; Cortaredona, Sébastien; Nauleau, S.; Sauze, Laurent; Sciortino, V.; Villani, Patrick; Verger, Pierre

doi:10.1016/j.pcd.2016.07.001

Cited by 7 publications

(7 citation statements)

References 32 publications

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“…Variability in clinical practice is a factor that influences the health of the population. It has been studied how professionals' knowledge and interest in specific pathologies influence the control of different health indicators [21,22,24]. On the other hand, another factor that influences care is continuity of care.…”

Section: Implications For Research and Practicementioning

confidence: 99%

“…Interventions in health centers aim to treat and control the disease and act on modifiable factors, following the recommendations of the different scientific societies [2,4,20]. Compliance with these recommendations is not as adequate as it could be, and there is significant variability depending on the different countries, regions, and even on the characteristics of the physician who monitors these patients [21][22][23]. How patients are cared for influences risk factors control, and treatment adherence [23,24].…”

Section: Introductionmentioning

confidence: 99%

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Variability in the Control of Type 2 Diabetes in Primary Care and Its Association with Hospital Admissions for Vascular Events. The APNA Study.

Guillen-Aguinaga¹,

Forga²,

Brugos-Larumbe³

et al. 2021

Preprint

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Type 2 diabetes (T2D) is associated with increased cardiovascular morbidity, mortality, and hospital admissions. There is variability in clinical practice. The objectives are to analyze the variability in the control of Blood Pressure (BP), HbA1c, and LDL-C in T2D patients and its influence on admissions due to cardiovascular events (CVE) Methods: We analyzed the electronic records in Primary Care Health centers in Navarra (Spain) and hospital admission for CVE. We follow 480637 people from 2012 to 2016. We calculated indicators of control of patients with T2D for each year, percentage with: HbA1c &lt; 7%; HbA1c &gt;= 9%; BP &lt;140/90 mmHg; LDL-C &lt;100 mg/dl. We used logistic and Cox regression. Results: Patients in the best control GP practices cluster are 2.5 times more likely to have HbA1c &lt;7% [OR: 2.46 (95% CI: 2.29-3.64)]. Poor HbA1c control ≥ 9% is more likely in the worst control cluster [OR: 1.73 (95% CI:1.63-1.83)]. The probability of admission for CVE increases with age, being male, low income, obesity, history of CVE, having HbA1c ≥ 9%, and belonging to a GP practice in the cluster of HbA1C ≥ 9% worst control. In contrast, it decreases in patients with HbA1c &lt;7%, BP&lt;140/90 mmHg and LDL &lt;100 mg/dl.

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Section: Implications For Research and Practicementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Variability in the Control of Type 2 Diabetes in Primary Care and Its Association with Hospital Admissions for Vascular Events. The APNA Study.

Guillen-Aguinaga¹,

Forga²,

Brugos-Larumbe³

et al. 2021

Preprint

View full text Add to dashboard Cite

show abstract

“…It has been clearly shown that the use of guidelines is associated with better prognosis, achieving target goals for HbA1c, blood pressure, renal function, and lipid profiles, as well as greater patient's satisfaction than when they are not used [ 12 – 14 ]. However, the adherence of healthcare professionals to recommendations of CPGs is unsatisfactory, with deficiencies in most areas of diabetes care and follow-up [ 15 – 19 ]. Barriers reported include lack of awareness, familiarity or agreement with the content, poor understanding of the need for change to overcome the inertia of normal practice, differences in the goals between clinicians and patients, and a number of external constraints associated with deficiencies in equipment and space, shortage of time, staff, and financial resources [ 20 – 23 ].…”

Section: Introductionmentioning

confidence: 99%

Factors Associated with Adherence to Clinical Practice Guidelines for Patients with Type 2 Diabetes Mellitus: Results of a Spanish Delphi Consensus

Gimeno

Cánovas

Durán

2021

Journal of Diabetes Research

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Objective. To assess factors associated with adherence to clinical practice guidelines (CPGs) for type 2 diabetes mellitus (T2DM). Methods. A cross-sectional multicenter study based on a two-round Delphi survey was designed. A total of 98 endocrinologists (mean age 45 years) involved in the care of T2DM patients completed a 43-item questionnaire assessing different aspects of adherence related to CPGs. Results. Most participants worked in tertiary care public hospitals. All participants used CPGs, with ADA/EASD as the most common (99%). The lack of time, establishment of an individualized management of patients, insufficient human resources, and therapeutic inertia were scored as the main reasons for not following CPGs recommendations. Participants agreed that insufficient material resources and limitations established by the healthcare system prevent adherence to CPGs. The risk of hypoglycemia was considered to be limiting factor for the patients’ integral control. Also, there was consensus on the need to have the support of nursing personnel with specific training in diabetes as well as dietitians and podiatrists. There was disagreement regarding the influence on adherence to CPGs of patient’s characteristics not matching those of CPGs, patient’s preferences, tolerability of the action recommended, concomitant comorbidities, or pluripathological conditions. Differences according to the participant’s age (≤40 years vs. >40 years) were not found. Therapeutic inertia and lack of time did not show a significant correlation. Conclusions. Nonadherence to CPGs on T2DM is a multifactorial problem but the existence multiple CPGs, the lack of time, the therapeutic inertia, and insufficient human resources have been identified as factors limiting adherence. Hypoglycemia continues to be a barrier for achievement of targets recommended by CPGs.

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“…In addition to screening for diabetes and its complications, clinical practice guidelines recommend specific process measures to guide care and glycemic control targets. 2 Effective therapeutic management has been shown to prevent or delay diabetes-associated complications. However, studies have demonstrated a breakdown in meeting these goals by patients, health care providers, and systems.…”

mentioning

confidence: 99%

“…However, studies have demonstrated a breakdown in meeting these goals by patients, health care providers, and systems. 2…”

mentioning

confidence: 99%

Facilitating Adherence to Evidence-Based Practices for Adults With Type 2 Diabetes Mellitus

Valencia¹,

Dols²

2021

The Journal for Nurse Practitioners

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Membership in a diabetes-care network and adherence to clinical practice guidelines for treating type 2 diabetes among general practitioners: A four-year follow-up

Cited by 7 publications

References 32 publications

Variability in the Control of Type 2 Diabetes in Primary Care and Its Association with Hospital Admissions for Vascular Events. The APNA Study.

Variability in the Control of Type 2 Diabetes in Primary Care and Its Association with Hospital Admissions for Vascular Events. The APNA Study.

Factors Associated with Adherence to Clinical Practice Guidelines for Patients with Type 2 Diabetes Mellitus: Results of a Spanish Delphi Consensus

Facilitating Adherence to Evidence-Based Practices for Adults With Type 2 Diabetes Mellitus

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