Adherence to clinical guidelines in the prevention of coronary heart disease in type II diabetes mellitus.
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).


METHODS
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.


METHODS
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.


CONCLUSIONS
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.
Kamyar
Majidreza
M
Department of Pharmacology and Toxicology, University of Vienna, Althanstrasse 14, Vienna 1090, Austria, majidreza_kamyar@yahoo.de
Johnson
B Julienne
BJ
McAnaw
John J
JJ
Lemmens-Gruber
Rosa
R
Hudson
Steve A
SA
D000328:Adult; D000368:Aged; D001241:Aspirin / Q000627:therapeutic use; D002985:Clinical Protocols; D003327:Coronary Disease / Q000209:etiology / Q000517:prevention & control*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D005260:Female; D019983:Guideline Adherence / Q000592:standards*; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D010380:Peer Review; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'
D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D010975:Platelet Aggregation Inhibitors; D001241:Aspirin