title: Evaluation of adherence to international guidelines for treating patients with type 2 diabetes mellitus in Kuwait.
abstract: BACKGROUND
  Clinical guidelines derived from scientific evidence provide the basis of consistent standardized prescribing. Despite an alarming increase of diabetes in Kuwait, no studies related to the quality of prescribing in diabetes were found. Before pharmaceutical care can be implemented to improve the quality of care of patients with diabetes, it is important to determine whether prescribers are compliant with comprehensive international guidelines for cardioprevention and glycaemic control.
  
  
  OBJECTIVE
  To evaluate the adherence to clinical guidelines for treating patients with type 2 diabetes mellitus in primary care centres and secondary care centres (hospitals) using a developed and validated medication assessment tool with reference to international guidelines.
  
  
  METHODS
  Outpatient diabetes clinics in 8 primary care centres and 4 secondary care centres across four healthcare regions in Kuwait.
  
  
  METHODS
  A quantitative, cross-sectional study involving a sample of 652 Kuwaiti patients with type 2 diabetes, who were selected using systematic sampling from the study settings. Data were collected retrospectively from the patients' medical records using a validated 43-criterion medication assessment tool (MATKW) designed to assess cardioprevention and treatment in patients with type 2 diabetes. Descriptive and comparative analysis was conducted using SPSS version 17.
  
  
  METHODS
  Frequency of prescribing adherence to agreed definitions of criteria derived from international guidelines.
  
  
  RESULTS
  Overall adherence to prescribing diabetes guidelines was 77.7 % (95 % CI 76.7-78.6 %). Significantly higher prescribing adherence was found in the secondary care facilities, 82.4 % (95 % CI 81.2-83.6 %) compared to primary care 72.5 % (95 % CI 71.0-73.9 %) (p < 0.001). Nineteen criteria out of 43 achieved an adherence >80 % in secondary care compared to ten criteria in primary care. The documentation of patients' records was found to be inconsistent at the study healthcare facilities. Nonoptimal achievement of target goals for HbA1c, blood pressure and BMI was prevalent among the study population.
  
  
  CONCLUSIONS
  A tool such as MATKW highlights areas for review and possible improvement in prescribing adherence. Our findings reveal problem areas in prescribing practices and documentation of patients' records. Cost-effective multifaceted interventions are needed to improve current prescribing practices and documentation.
authors.affiliation: Strathclyde Institute of Pharmacy and Biomedical Science, University of Strathclyde, Glasgow, UK.
authors.forename: Dalal M
authors.initials: DM
authors.lastname: Al-Taweel
authors.forename: Abdelmoneim I
authors.initials: AI
authors.lastname: Awad
authors.forename: B Julienne
authors.initials: BJ
authors.lastname: Johnson
mesh_terms: D000368:Aged; D000553:Ambulatory Care / Q000592:standards; D001794:Blood Pressure; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000517:prevention & control; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000188:drug therapy*; D004282:Documentation / Q000592:standards; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D038622:Internationality; D007730:Kuwait; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D011320:Primary Health Care / Q000592:standards; D011787:Quality of Health Care; D012189:Retrospective Studies
chemical_list: D007004:Hypoglycemic Agents