title: Repeat prescriptions of guideline-based secondary prevention medication in patients with type 2 diabetes and previous myocardial infarction in Dutch primary care.
abstract: BACKGROUND
  Secondary prevention is efficient in reducing morbidity and mortality after a myocardial infarction (MI). However, both short-term and long-term mortality after MI remains relativity high in type 2 diabetes patients.
  
  
  OBJECTIVE
  To evaluate repeat prescriptions of secondary prevention medication (anti-thrombotic agent, beta-blocker and statin) in type 2 diabetes patients with a previous MI.
  
  
  METHODS
  Data of 1009 type 2 diabetes patients with a previous MI were extracted from the Julius General Practitioners' Network database. The proportion of patients with recent repeat prescriptions of guideline-based medication was determined. Furthermore, repeat prescriptions was determined 6 months, 1 year, 2 years and 5 years after MI. Generalized linear models were used to examine changes over time. Multivariate logistic regression analysis was used to analyse the association between patient characteristics and prescription.
  
  
  RESULTS
  Only 46% of all type 2 diabetes patients with a previous MI had a recent repeat prescription for all three medicines. An increase in prescription over time was found for statins (P = 0.001). Older aged people [odds ratio (OR): 0.99, 95% confidence interval (CI): 0.98-1.00] were less likely to receive the combination of all three.
  
  
  CONCLUSIONS
  A substantial proportion of type 2 diabetes patients with a previous MI did not receive guideline-based secondary prevention. Prescription rates were quite stable over time. This study confirms the need for a different approach to achieve an improvement of secondary prevention in type 2 diabetes patient with a previous MI. GPs can play an important role in this respect by being extra alert that prescription occurs according to the guidelines.
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht and M.J.Kasteleyn@umcutrecht.nl.
authors.forename: Marise J
authors.initials: MJ
authors.lastname: Kasteleyn
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht and.
authors.forename: Aryan
authors.initials: A
authors.lastname: Wezendonk
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht and.
authors.forename: Rimke C
authors.initials: RC
authors.lastname: Vos
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht and Department for Public Health and Primary Care, Leiden University Medical Centre, Leiden, the Netherlands.
authors.forename: Mattijs E
authors.initials: ME
authors.lastname: Numans
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht and.
authors.forename: Hanneke
authors.initials: H
authors.lastname: Jansen
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht and.
authors.forename: Guy E H M
authors.initials: GE
authors.lastname: Rutten
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000368:Aged; D015897:Comorbidity; D016208:Databases, Factual; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy* / Q000453:epidemiology; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D008297:Male; D009203:Myocardial Infarction / Q000188:drug therapy / Q000453:epidemiology / Q000517:prevention & control*; D009426:Netherlands / Q000453:epidemiology; D017410:Practice Guidelines as Topic; D011320:Primary Health Care / Q000379:methods / Q000592:standards / Q000706:statistics & numerical data; D012008:Recurrence; D012307:Risk Factors; D055502:Secondary Prevention / Q000379:methods / Q000592:standards / Q000706:statistics & numerical data*; D017678:Sex Distribution
chemical_list: D000319:Adrenergic beta-Antagonists; D005343:Fibrinolytic Agents; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors
keywords: Hospital discharge; multidisciplinary care; myocardial infarction; secondary prevention; type 2 diabetes.