Attainment of Canadian Diabetes Association recommended targets in patients with type 2 diabetes: a study of primary care practices in St John's, Nfld.
OBJECTIVE
To examine the degree to which targets for diabetes (blood pressure [BP], glycated hemoglobin [HbA1c], and low-density lipoprotein cholesterol [LDL-C]) are achieved in family practices and how these results compare with family physicians' perceptions of how well targets are being achieved.


METHODS
Chart audit and physician survey.


METHODS
Newfoundland and Labrador.


METHODS
Patients with type 2 diabetes and their family physicians.


METHODS
The charts of 20 patients with type 2 diabetes were randomly chosen from each of 8 family physician practices in St John's, Nfld, and data were abstracted. All family physicians in the province were surveyed using a modified Dillman method.


METHODS
The most recent HbA1c, LDL-C, and BP measurements listed in each audited chart; surveyed family physicians' knowledge of the recommended targets for HbA1c, LDL-C, and BP and their estimates of what percentage of their patients were at those recommended targets.


RESULTS
The chart audit revealed that 20.6% of patients were at the recommended target for BP, 48.1% were at the recommended target for HbA1c, and 17.5% were at the recommended target for LDL-C. When targets were examined collectively, only 2.5% of patients were achieving targets in all 3 areas. The survey found that most family physicians were aware of the recommended targets for BP, LDL-C, and HbA1c. However, their estimates of the percentages of patients in their practices achieving these targets appeared high (59.3% for BP, 58.2% for HbA1c, and 48.4% for LDL-C) compared with the results of the chart audit.


CONCLUSIONS
The findings of the chart audit are consistent with other published reports, which have illustrated that a large majority of patients with diabetes fall short of reaching recommended targets for BP, blood glucose, and lipid levels. Although family physicians are knowledgeable about recommended targets, there is a gap between knowledge and clinical outcomes. The reasons for this are likely multifactorial. Further investigation is needed to better understand this phenomenon as well as to understand the foundation for physicians' optimistic estimates of how many of their patients with diabetes were reaching target values.
McCrate
Farah
F
Office for Aging and Seniors, Department of Health and Community Services, Newfoundland and Laborador, St. John's.
Godwin
Marshall
M
Murphy
Laura
L
D001794:Blood Pressure; D001795:Blood Pressure Determination; D008078:Cholesterol, LDL / Q000097:blood; D002983:Clinical Competence / Q000592:standards*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000175:diagnosis / Q000628:therapy*; D005194:Family Practice; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D008485:Medical Audit / Q000706:statistics & numerical data; D008875:Middle Aged; D009523:Newfoundland and Labrador; D010043:Outcome and Process Assessment, Health Care; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D012015:Reference Standards; D012044:Regression Analysis
D008078:Cholesterol, LDL; D006442:Glycated Hemoglobin