Quality of diabetes care and coronary heart disease absolute risk in patients with type 2 diabetes mellitus in Australian general practice

Abstract

Objective: To examine the quality of diabetes care and prevention of cardiovascular disease (CVD) in Australian general practice patients with type 2 diabetes and to investigate its relationship with coronary heart disease absolute risk (CHDAR). Methods: A total of 3286 patient records were extracted from registers of patients with type 2 diabetes held by 16 divisions of general practice (250 practices) across Australia for the year 2002. CHDAR was estimated using the United Kingdom Prospective Diabetes Study algorithm with higher CHDAR set at a 10 year risk of .15%. Multivariate multilevel logistic regression investigated the association between CHDAR and diabetes care. Results: 47.9% of diabetic patient records had glycosylated haemoglobin (HbA1c) .7%, 87.6% had total cholesterol >4.0 mmol/l, and 73.8% had blood pressure (BP) >130/85 mm Hg. 57.6% of patients were at a higher CHDAR, 76.8% of whom were not on lipid modifying medication and 66.2% were not on antihypertensive medication. After adjusting for clustering at the general practice level and age, lipid modifying medication was negatively related to CHDAR (odds ratio (OR) 0.84) and total cholesterol. Antihypertensive medication was positively related to systolic BP but negatively related to CHDAR (OR 0.88). Referral to ophthalmologists/optometrists and attendance at other health professionals were not related to CHDAR. Conclusions: At the time of the study the diabetes and CVD preventive care in Australian general practice was suboptimal, even after a number of national initiatives. The Australian Pharmaceutical Benefits Scheme (PBS) guidelines need to be modified to improve CVD preventive care in patients with type 2 diabetes.

Glycemic Control and Accompanying Risk Factors: 4-Year Primary Care Study

“…This percentage was almost maintained during the follow-up period. Studies showed wide variation of the percentage of those who reached the LDL goal (15% to 87%) [30,31]. The problem in our study in addition to the modest control of LDL was that our PHC providers failed to make significant change in the number of controlled patients, dislike the findings of Ackermann study who reported the positive change of 20.5% [42].…”

“…These findings were far less than RECAP-DM study findings were 27% of diabetic patients in 7 European countries have HbA1c of <6.5%, (RECAP study) and 31% in CODE study and 33.5% in US study [28,29]. Other study showed even better HbA1c readings which reached up to 47% [30,31].…”

Influence of chronic comorbidity and medication on the efficacy of treatment in patients with diabetes in general practice

“…[3][4][5] However, as shown in many observational studies in primary care, only about half of those patients who have type 2 diabetes achieve this. [6][7][8][9] There are several reasons for this quality gap.…”

Behavioural innovation is key to improving the health of one million Australians living with type 2 diabetes

“…People with diabetes are two to four times more likely to develop cardiovascular disease and about two thirds die from it. Wan, et al (2006) ;Taggart, et al (2008) Undiagnosed kidney disease is also common in people with diabetes.…”

“…Even among those with severe conditions, only half were provided with 15 Middleton, et al (2005) 16 Afkarian, et al (2013) 17 Wan, et al (2006) 18 Australian Bureau of Statistics (2008) specific psychological or pharmacological treatment. 19 There has been considerable expansion of primary health services in the meantime, but significant concerns about their distribution and entitlements to services remain.…”