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Papanas N, Elisaf M, Kotsa K, Melidonis A, Bousboulas S, Bargiota A, Pagkalos E, Doupis J, Ioannidis I, Avramidis I, Pappas AC, Karousos G, Arvaniti E, Bristianou M, Pietri K, Karamousouli E, Voss B, Migdalis I, Tentolouris N. Adherence to the National Guidelines for Follow-Up Protocol in Subjects with Type 2 Diabetes Mellitus in Greece: The GLANCE Study. Diabetes Ther 2020; 11:2887-2908. [PMID: 33011924 PMCID: PMC7644661 DOI: 10.1007/s13300-020-00935-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 09/19/2020] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Physician adherence, or lack therefore, to diabetes care and follow-up guidelines may be linked to the rates of achieving suboptimal glycaemic, blood pressure and lipid targets in people with type 2 diabetes mellitus (T2DM). In this cross-sectional study we evaluated physician adherence to the patient follow-up protocol (PFP) of the 2017 Hellenic Diabetes Association (HDA) guidelines and also assessed glycated haemoglobin (HbA1c), blood pressure and lipid control achievement rates in the routine care setting in Greece. METHODS Eligible subjects were adults with T2DM receiving oral hypoglycaemic agents (OHAs) for ≥ 1 year who had ≥ 2 HbA1c measurements in the previous year and an HbA1c target < 7%. Overall adherence at the subject level was defined as the percentage of the 62 HDA PFP items that had been met during the past year. RESULTS Between June and December 2018, 601 eligible subjects (54.6% men; mean age 65.2 years; median T2DM duration 5.9 years, of whom 96.5% had ≥ 1 medical condition/comorbidity), were enrolled into the study by 53 hospital- and office-based endocrinologists, internists and general practitioners. The main OHAs prescribed at enrolment were metformin (91.0%), dipeptidyl peptidase-4 inhibitors (60.7%), sodium-glucose co-transporter-2 inhibitors (23.5%) and sulphonylureas (16.3%). Mean overall physician adherence to the PFP was 43.6%. Predictors of greater higher physicans' adherence were female sex (p = 0.026), > 3 medical conditions/comorbidities (p = 0.043) and diabetic complications (p < 0.001). HbA1c, low-density lipoprotein-cholesterol, systolic/diastolic blood pressure and composite metabolic targets were achieved by 82.1, 57.0, 42.6 and 21.6% of subjects, respectively. CONCLUSIONS In Greek routine care, physician adherence to the PFP of the 2017 HDA guidelines is suboptimal. Future efforts should focus on identifying the barriers to an adequate adherence by physicians to the full PFP, with the aim to provide optimal patient care.
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Affiliation(s)
- Nikolaos Papanas
- Diabetes Centre, Second Department of Internal Medicine, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece.
| | - Moses Elisaf
- Department of Internal Medicine, School of Health Sciences, Faculty of Medicine, University of Ioannina, Ioannina, Greece
| | - Kalliopi Kotsa
- Division of Endocrinology and Metabolism-Diabetes Centre, First Department of Internal Medicine, AHEPA University Hospital, Aristotle University of Thessaloniki School of Medicine, Thessaloniki, Greece
| | | | | | - Alexandra Bargiota
- Department of Endocrinology and Metabolic Diseases, University Hospital of Larissa, Thessaly, Greece
| | | | - John Doupis
- Department of Internal Medicine and Diabetes, Salamis Naval and Veterans Hospital, Salamis Naval Base, Salamina, Greece
| | - Ioannis Ioannidis
- First Department of Internal Medicine, Konstantopouleio Hospital, Athens, Greece
| | - Iakovos Avramidis
- Internal Medicine Department and Diabetes Centre, George Papanikolaou" General Hospital, Thessaloniki, Greece
| | - Angelos C Pappas
- Diabetes Centre, Venizelio General Hospital Heraklion, Heraklion, Crete, Greece
| | - Gerasimos Karousos
- Department of Internal Medicine and Diabetes, Athens Medical Group, Psychiko, Athens, Greece
| | - Eleni Arvaniti
- General Hospital of Ioannina "G. Hatzikosta", Ioannina, Greece
| | | | | | | | - Bernd Voss
- Merck Sharp and Dohme (MSD) RBSC GmbH, Haar, Germany
| | - Ilias Migdalis
- Second Medical Department and Diabetes Centre, NIMTS Hospital, Athens, Greece
| | - Nikolaos Tentolouris
- First Department of Propaedeutic Internal Medicine, Laiko General Hospital, National Kapodistrian University of Athens Medical School, Athens, Greece
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Ahnfeldt-Mollerup P, Søndergaard J, Barwell F, Mazelan PM, Spurgeon P, Kristensen T. The Relationships Between Use of Quality-of-Care Feedback Reports on Chronic Diseases and Medical Engagement in General Practice. Qual Manag Health Care 2018; 27:191-8. [PMID: 30260925 DOI: 10.1097/QMH.0000000000000188] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND There is a limited knowledge on how medical engagement influences quality of care provided in primary care. The extent of the use of feedback reports from a national quality-of-care database can be considered as a measure of process quality. This study explores relationships between the use of feedback reports and medical engagement among general practitioners, general practitioner demographics, clinic characteristics, and services. METHODS A cross-sectional combined questionnaire and register study in a sample of 352 single-handed general practitioners in 2013. Logistic regression analysis was used to explore associations between the use of feedback reports for diabetes and chronic obstructive pulmonary disease and medical engagement. RESULTS For both diabetes and chronic obstructive pulmonary disease, a higher degree of medical engagement was associated with an increased use of feedback reports. Furthermore, we identified positive associations between using feedback reports and general practitioner services (spirometry, influenza vaccinations, performing annual reviews for patients with chronic diseases) and a negative association between usage of quality-of-care feedback reports and the number of consultations per patient. CONCLUSION Using feedback reports for chronic diseases in general practice was positively associated with medical engagement and also with the provision of services in general practice.
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Scherz N, Valeri F, Rosemann T, Djalali S. Quality of secondary prevention of coronary heart disease in Swiss primary care: Lessons learned from a 6-year observational study. Z Evid Fortbild Qual Gesundhwes 2016; 118-119:40-47. [PMID: 27987567 DOI: 10.1016/j.zefq.2016.06.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Revised: 06/27/2016] [Accepted: 06/28/2016] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Across Europe, great variations have been identified in the quality of preventive healthcare services delivered in primary care (PC). We aimed to assess the quality of secondary prevention in Swiss PC patients with coronary heart disease (CHD) and its evolution over six years. METHODS In the database of the Swiss «Family Medicine ICPC Research using Electronic Medical Records» (FIRE) project, we identified electronical record data of 2,807 patients with CHD treated for at least 15 months between 2009 and 2014. Primary outcome was the proportion of patients per year meeting four quality indicators of the British Quality and Outcome Framework (QOF): 1) blood pressure (BP) ≤ 150mmHg, 2) total serum cholesterol ≤ 5mmol/L, 3) prescription of anti-platelet therapy, 4) recommended drug prescriptions for patients with previous myocardial infarction (MI). Secondary outcome was the proportion of patients who were ineligible for indicator calculation because of incomplete record data. RESULTS From 2009 to 2014, 85.9, 83.1, 82.0, 81.9, 81.5, and 81.0 % of the patients met BP targets and 73.6, 77.0, 69.2, 73.6, 69.4, and 69.1% met cholesterol targets. Anti-platelet therapy was prescribed to 74.8, 76.1, 73.9, 70.2, 72.2, and 72.5 % of the patients. Finally, 83.3, 84.4, 87.5, 75.6, 89.8, and 89.2 % of the patients with previous MI received the recommended drug therapy. Changes over time were not significant. Missing BP records concerned 12.4-15.9 % of the patients, and missing cholesterol records 69.0-75.6 %. Females and patients with less cardiovascular comorbidities were more likely to show missing records. CONCLUSIONS Quality of secondary prevention did not improve when measured against QOF indicators in the period under investigation. Missing data in electronic medical records inhibited full quality indicator assessment. Especially in female patients and those with less cardiovascular comorbidity, closer medical documentation should be encouraged in order to facilitate quality of care measurements.
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Affiliation(s)
- Nathalie Scherz
- Institute of Primary Care, University of Zurich, University Hospital Zurich, Zurich, Switzerland
| | - Fabio Valeri
- Institute of Primary Care, University of Zurich, University Hospital Zurich, Zurich, Switzerland
| | - Thomas Rosemann
- Institute of Primary Care, University of Zurich, University Hospital Zurich, Zurich, Switzerland
| | - Sima Djalali
- Institute of Primary Care, University of Zurich, University Hospital Zurich, Zurich, Switzerland.
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