Appropriate intensification of diabetes-related therapy by general practitioners: cross sectional study

Abstract

ABSTRACTAimTo measure intensification of therapy (the inverse of clinical inertia) by general practitioners in the management of hyperglycaemia, hypertension and dyslipidaemia in patients with diabetes.MethodsWe analysed clinical practices results for Hb1c, blood pressure, lipids and pharmacy records for prescriptions according to the guidelines. We identified whether medication was increased at each patient visit when the goals for glycosylated haemoglobin (<= 64 mmol/mol), systolic blood pressure (<=130 mmHg) and LDL cholesterol (<=3.5 mmol/L) had not been reached at the time of the visit. The study was conducted between January 2009 and December 2011 in South Auckland, New Zealand.ResultsData from 314 patients with diabetes included 2398 prescriptions. Appropriate intensification of therapy was seen in 31% of 457 visits when HbA1c was raised, 11% of 375 visits when systolic blood pressure was raised and 2% of 51 visits when LDL cholesterol was raised.ConclusionsThere are clear differences in intensification therapy in terms of the co-morbidity addressed. Clinical inertia may be one important and changeable contributor to diabetes complications. New Zealand has replaced “get Checked” programme for Diabetes Care Improvement Package, which is a primary care based programme seeking to improve outcomes for people with diabetes. This new programme is based on coordination of diabetes care, therefore a further analysis measuring clinical inertia may show improvements in quality, consistency and direction of care for people with diabetes in New Zealand.HighlightsWe measure intensification of therapy by general practitioners.Management of hyperglycaemia, hypertension and dyslipidaemia were tested.There are differences in intensification therapy in terms of each co-morbidity.Clinical inertia may be one changeable contributor to diabetes complications.