Adherence to clinical guidelines in the prevention of coronary heart disease in type II diabetes mellitus
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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.
KeywordsCardiovascular disease Clinical guideline Community pharmacy Diabetes mellitus Primary prevention Public health Scotland Secondary prevention
The study had been approved by the Argyll and Clyde Local Research Ethics Committee.
Conflict of interest
There are no conflict of interest.
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