Linking pharmacy and laboratory data to assess the appropriateness of care in patients with diabetes.
OBJECTIVE
To use pharmacy and laboratory data to assess diabetes care within a medical group and between medical groups and to determine dispensing patterns and the extent to which providers change therapy based on HbA1c results.


METHODS
Participating groups submitted 1 year of data for continuously enrolled patients. Required data included date of birth, all diabetes-specific prescriptions (oral hypoglycemic agents and insulin), date of prescription, National Drug Code, all HbA1c values, lower and upper normal limits, and date of testing.


RESULTS
Few changes in therapy were noted despite the large percentages of patients with suboptimal control. Nearly 90% of the patients treated with medications received a monotherapy regimen involving one of three therapeutic agents: sulfonylureas, metformin, or insulin. More than three-fourths of the patients remained on the same therapy during the observation period despite the fact that 27% of these patients had HbA1c values > or = 8%. Nearly one-fifth (18%) of patients had an HbA1c level of > or = 8% and no further testing for at least 90 days after the "actionable" HbA1C result was obtained. Furthermore, 54% of patients with actionable HbA1c results did not have a change in therapy initiated after the result was available.


CONCLUSIONS
The American Diabetes Association recommendations to act on HbA1c values > or = 8% and to follow up regularly on patients found to be in suboptimal control do not appear to be applied in a consistent manner based on the pharmacy and laboratory data analyzed in this sample.
Wetzler
H P
HP
American Medical Group Association, Bainbridge Island, Washington, USA. hwetz@aol.com
Snyder
J W
JW
D000368:Aged; D019411:Clinical Laboratory Techniques / Q000592:standards*; D003920:Diabetes Mellitus / Q000097:blood / Q000188:drug therapy / Q000628:therapy*; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis*; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D010594:Pharmacies / Q000592:standards*; D012016:Reference Values; D012955:Societies, Medical; D014481:United States; D014837:Voluntary Health Agencies
D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents