التفاصيل البيبلوغرافية
| العنوان: |
Failure to Intensify Oral Antidiabetic Medications in Primary Care. |
| المؤلفون: |
Bricker, Eric, Bolen, Shari, Samuels, Alafia, Yeh, Jessica, Marinopoulos, Spyridon, Brancati, Frederick |
| المصدر: |
Diabetes; Jun2007 Supplement 1, Vol. 56, pA308-A308, 1/4p |
| مصطلحات موضوعية: |
HYPOGLYCEMIC agents, ORAL therapy for diabetes, INSULIN therapy, TYPE 2 diabetes, PEOPLE with diabetes, PRIMARY care |
| مستخلص: |
Background: Although suboptimal glycemic control is known to be common in diabetic adults, few studies have attempted to determine explanatory factors at the level of the physician-patient encounter. We hypothesized that 1) failure to appropriately intensify treatment is a common explanatory factor and 2) characteristics of the patient and the visit influence the risk of failure. Methods: To test these hypotheses, we conducted a non-concurrent cohort study of 411 patients with type 2 diabetes enrolled in a managed care program. In this analysis, we focused on the subset of 122 subjects who were taking only oral antidiabetic medications and excluded insulin users, since intensification of insulin therapy is difficult to track. From 01/01/00-12/31/01, we abstracted medical record data on every primary care visit and linked it to electronic administrative and pharmacy data. Intensification was defined as dose advancement or addition of a new drug. We used generalized estimating equations to construct a multivariable logistic regression model, which accounted for clustering by the patient. Results: During 24 months of follow-up, there were 674 visits at which glycemia was sub-optimally controlled (A[sub 1c] ≥ 8% or blood glucose ≥ 150 mg/dL). Physicians appropriately intensified oral antidiabetic treatment in only 175 of these visits [26%; 95% Confidence Interval (CI) 23-30%]. As expected, A1c ≥ 9% was a strong predictor of intensification [Odd Ratio (OR) 2.2; 95% CI 1.4-3.4]. In multivariable analyses simultaneously adjusted for patient, physician, and glycemic control, the following independent predictors of intensification emerged: current regimen of 2 or more oral antidiabetic agents [OR 2.1; 95% CI 1.4-3.3], a visit that was 'routine' (OR 2.4; 95% CI 1.5-3.9), and patient age [OR 1.35; 95% CI 1.003-1.83 per 10 years]. In contrast, physicians were 55% less likely to intensify treatment for African American patients vs their Caucasian counterparts [OR 0.45; 95% CI 0.28-0.72]. Physician age, gender and year of graduation as well as patient gender and co-morbidities were not associated with treatment intensification. Conclusions: Failure to appropriately intensify oral hypoglycemic medications was a common problem in diabetes care. Failure was less likely in older patients on multiple drugs in poor control, but more likely for African Americans. Quality improvement measures in type 2 diabetes should focus on reducing racial disparities and overcoming inertia. [ABSTRACT FROM AUTHOR] |
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| قاعدة البيانات: |
Complementary Index |
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