Cardiometabolic treatment decisions in patients with type 2 diabetes: the role of repeated measurements and medication burden.
PURPOSE: Clinical guidelines for cardiometabolic risk management indicate a simple threshold-based strategy for treatment, but physicians and their patients may be reluctant to modify drug treatment after a single elevated measurement. We determined how repeated measurements of blood pressure, chole...
| Publicado en: | Quality & Safety in Health Care Vol. 19; no. 5; pp. 411 - 416 |
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| Autores principales: | , , , , |
| Formato: | research tables/charts Journal Article |
| Publicado: |
BMJ Publishing Group
Oct2010
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105014163&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 105014163 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 14753898 C0K jtl: Quality & Safety in Health Care issn: 14753898 maglogo: N pubinfo: dt: Oct2010 vid: 19 iid: 5 pid: 8280 pub: BMJ Publishing Group artinfo: ui: 105014163 2010846739 10.1136/qshc.2008.030106 NLM20427303 105014163 ppf: 411 ppct: 5 formats: tig: atl: Cardiometabolic treatment decisions in patients with type 2 diabetes: the role of repeated measurements and medication burden. aug: au: Voorham J Haaijer-Ruskamp FM Wolffenbuttel BHR Stolk RP Denig P affil: Disciplinegroep Klinische Farmacologie, Universitair Medisch Centrum Groningen, Sector F, Antonius Deusinglaan 1, 9713 AV Groningen, The Netherlands. j.voorham@epi.umcg.nl sug: subj: Cardiovascular Risk Factors Decision Making, Clinical Diabetes Mellitus, Type 2 Drug Therapy Repeated Measures Antihypertensive Agents Therapeutic Use Blood Pressure Determination Cholesterol Blood Cluster Analysis Guideline Adherence Glycated Hemoglobin Blood Human Hyperglycemia Drug Therapy Multiple Logistic Regression Netherlands Odds Ratio Physicians, Family Netherlands Predictive Validity Prospective Studies ab: PURPOSE: Clinical guidelines for cardiometabolic risk management indicate a simple threshold-based strategy for treatment, but physicians and their patients may be reluctant to modify drug treatment after a single elevated measurement. We determined how repeated measurements of blood pressure, cholesterol and haemoglobin A1c affect general practitioners' decisions to start or intensify medication in patients with type 2 diabetes. We also evaluated whether medication burden altered these decisions. METHODS: We conducted a cohort study in 3029 patients managed by 62 general practitioners (GPs). We assessed the predictive value of the last risk factor measurement, the number of successive measurements above target level and the percentage change between the last two measurements. Medication burden was assessed as the number of drugs concurrently used. Effects on treatment decisions were estimated by multilevel logistic regression analysis, correcting for clustering at GP level. RESULTS: Repeated high levels of diastolic blood pressure increased the likelihood to start antihypertensive medication (OR=2.08, CI 1.37 to 3.17). Repeated high haemoglobin A1c levels affected intensification of oral glucose-lowering medication (OR=1.71, CI 1.44 to 2.03). Modification of lipid-lowering medication was limited, and only affected by the last total cholesterol level. Starting treatment for all three risk factors, as well as intensifying antihypertensive treatment, was more likely in patients already using more drugs for other chronic diseases. CONCLUSIONS: Waiting for the next measurement before deciding to change medication can explain in part the apparent undertreatment for hypertension and hyperglycaemia, but not for hypercholesterolaemia. Medication burden was not a barrier for treatment modification. pubtype: Academic Journal doctype: research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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