Adherence to clinical guidelines in the prevention of coronary heart disease in type II diabetes mellitus
Purchase on Springer.com
$39.95 / €34.95 / £29.95*
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.
Objective The study aimed to assess adherence of prescribed medication in primary care to nationally recognised guideline criteria using case note review applying a previously developed medication assessment tool for coronary heart disease (MAT-CHD). Setting Primary care medical centre serving 17,991 patients. A sample of 208 from 463 patients with type 2 diabetes aged 20–75 years with or without a history of ischaemic heart disease (IHD). Method Patients’ records were accessed via medical and pharmacy databases. The criteria of the 23-item audit tool were applied to medical records from case notes in order to quantify adherence to individual guideline criteria. Main outcome measure Frequency of adherence to agreed definitions of medication use quality criteria. Results A total of 1,433 guideline criteria were applied and 1,107 (77.2%, CI: 75.0, 79.4) criteria standards were met with 326 (22.7%, CI: 20.6, 25.0) non-adherences. The overall adherence to guideline criteria was significantly lower for secondary prevention than for primary prevention (74.4 vs. 80.1%, P < 0.05; Chi square). Justification recorded in the case notes was identified for 54 (17%, CI: 13, 21) of those non-adherences. Conclusion The MAT-CHD highlighted areas for review and possible improvement. The tool can be used in primary care from case record examination and offers a means of co-operation between community pharmacists and general practitioners in clinical guideline implementation.
- Giorgino F, Laviola L, Leonardini A. Pathophysiology of type 2 diabetes: rationale for different oral antidiabetic treatment strategies. Diabetes Res Clin Pract 2005;68:22–9. CrossRef
- Niessen LW, Dijkstra R, Hutubessy R, Rutten GE, Casparie AF. Lifetime health effects and costs of diabetes treatment. Neth J Med 2003;61:355–64.
- Fitzsimons B, Wilton L, Lamont T, McCulloch L, Boyce J. The Audit Commission review of diabetes services in England and Wales, 1998–2001. Diabet Med 2002;19:73–8. CrossRef
- Scottish Diabetes Survey Monitoring Group/SEHD. Scottish Diabetes Survey 2001. (Accessed vis http://www.diabetesinscotland.org).
- Scottish Executive Health Department. 2002. Scottish Diabetes Framework. Edinburgh: The Stationary Office (April 2003).
- Diabetes in Minority Ethnic Groups in Scotland. A report by the National Resource Center for Ethnic Minority Health in collaboration with the Scottish Diabetes Group; 2004;Chapters 1 & 2.
- American Diabetes Association (ADA). Report of the expert committee on the diagnosis and classification of diabetes mellitus. Diabetes Care 2004;27:5. CrossRef
- Rajaei-Dehkordi Z, Hollingshead C, et al. Investigating the contribution of Community pharmacists in identifying, understanding and meeting the needs of patients with diabetes, in collaboration with other healthcare professionals. Int J Pharm Prac 2003;11:R18.
- Scottish Intercollegiate Guidelines Network. SIGN Publication Number 41. Secondary prevention of coronary heart disease following myocardial infarction. A National Clinical Guideline. Scottish Intercollegiate Guidelines Network: Edinburgh 2000 (accessed via http://www.sign.ac.uk).
- Scottish Intercollegiate Guidelines Network. SIGN Publication Number 51. Management of stable angina. A National Clinical Guideline. Scottish Intercollegiate Guidelines Network: Edinburgh 2001 (accessed via http://www.sign.ac.uk).
- Chinwong S, Power A, Kesson C, Hudson S. Prescribing for cardioprevention in type 2 diabetes: Adherence to National Guidelines. American Heart Association. 5th Scientific Forum on Quality of Care and Outcomes Research in Cardiovascular Disease and Stroke. Washington. 2004. (published in Circulation 2004;109(20):P200).
- Scottish Intercollegiate Guidelines Network. SIGN Publication Number 55. Management of Diabetes. A National Clinical Guideline. Scottish Intercollegiate Guidelines Network: Edinburgh 2004 (accessed via http://www.sign.ac.uk).
- Ernst A, Kinnear M, Hudson S. Quality of prescribing: A study of guideline adherence of medication in patients with diabetes mellitus. Prac Diab Int 2005;22:285–90. CrossRef
- Stratton IM, Adler AI, Neil HA, Matthews DR, et al. Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective observational study. Brit Med J 2000;32:405–12. CrossRef
- Kuusisto J, Mykkänen L, Pyörälä K, Laakso M. NIDDM and its metabolic control predict coronary heart disease in elderly subjects. Diabetes 1994;43:960–7. CrossRef
- Gross R, Tabenkin H, Porath A, et al. The relationship between primary care physicians’ adherence to guidelines for the treatment of diabetes and patient satisfaction: findings from a pilot study. Farm Pract 2003;20:563–9. CrossRef
- Lerman I. Adherence to treatment: the key for avoiding long-term complications of diabetes. Arch Med Res 2005;36:300–6. CrossRef
- Godley PJ, Maue SK, Farrelly EW, Frech F. The need for improved medical management of patients with concomitant hypertension and type 2 diabetes mellitus. Am J Manag Care 2005;11:206–10.
- Antithrombotic trialists’ collaboration. Collaborative meta-analysis of Randomised trials of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high risk patients. Brit Med J 2002;324:71–86. CrossRef
- The Joint British Societies’ Guidelines on the Prevention of Cardiovascular Disease in Clinical Practice: Risk Assessment (JBS2 guidelines). January 2006 (Access via http://www.bhsoc.org/bhf_factfiles/bhf_factfile_jan_2006.pdf).
- EUROASPIRE. A European Society of Cardiology survey of secondary prevention of coronary heart disease: principal results. EUROASPIRE Study Group. European Action on Secondary Prevention through Intervention to Reduce Events. Eur Heart J 1997;18:1569–82.
- Adherence to clinical guidelines in the prevention of coronary heart disease in type II diabetes mellitus
Pharmacy World & Science
Volume 30, Issue 1 , pp 120-127
- Cover Date
- Print ISSN
- Online ISSN
- Springer Netherlands
- Additional Links
- Cardiovascular disease
- Clinical guideline
- Community pharmacy
- Diabetes mellitus
- Primary prevention
- Public health
- Secondary prevention
- Industry Sectors
- Author Affiliations
- 1. Department of Pharmacology and Toxicology, University of Vienna, Althanstrasse 14, Vienna, 1090, Austria
- 2. Department of Pharmaceutical Sciences, University of Strathclyde, Glasgow, UK