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

Citation
Hp. Wetzler et Jw. Snyder, Linking pharmacy and laboratory data to assess the appropriateness of carein patients with diabetes, DIABET CARE, 23(11), 2000, pp. 1637-1641
Citations number
20
Categorie Soggetti
Endocrynology, Metabolism & Nutrition","Endocrinology, Nutrition & Metabolism
Journal title
DIABETES CARE
ISSN journal
01495992 → ACNP
Volume
23
Issue
11
Year of publication
2000
Pages
1637 - 1641
Database
ISI
SICI code
0149-5992(200011)23:11<1637:LPALDT>2.0.ZU;2-X
Abstract
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.