Linking pharmacy and laboratory data to assess the appropriateness of carein patients with diabetes

OBJECTIVE - To use pharmacy and laboratory data to assess diabetes care wit hin 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 up per normal limits, and date of testing. RESULTS - Few changes in therapy were noted despite the large percentages o f patients with suboptimal control. Nearly 90% of the patients treated with medications received a monotherapy regimen involving one of three therapeu tic agents: sulfonylureas, metformin, or insulin. More than three-fourths o f the patients remained on the same therapy during the observation period d espite the fact that 27% of these patients had HbA(1c) values greater than or equal to8%. Nearly one-fifth (18%) of patients had an HbA(1c) level of g reater than or equal to8% 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 H bA(1c) values greater than or equal to8% and to follow up regularly on pati ents found to be in suboptimal control do not appear to be applied in a con sistent manner based on the pharmacy and laboratory data analyzed in this s ample.