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Adherence to clinical practice guidelines and outcomes in diabetic patientsopen access

Authors
Oh S.-W.Lee H.J.Chin H.J.Hwang J.-I.
Issue Date
2011
Keywords
Clinical practice guideline; Diabetes; Guideline adherence; Outcome
Citation
International Journal for Quality in Health Care, v.23, no.4, pp.413 - 419
Indexed
SCIE
SSCI
SCOPUS
Journal Title
International Journal for Quality in Health Care
Volume
23
Number
4
Start Page
413
End Page
419
URI
https://scholarworks.korea.ac.kr/kumedicine/handle/2020.sw.kumedicine/14137
DOI
10.1093/intqhc/mzr036
ISSN
1353-4505
Abstract
Objective. To examine the level of adherence to clinical practice guidelines and its relationship to outcomes in patients with diabetes. Design. Retrospective cohort study. Setting. A tertiary teaching hospital in Korea. Participants. Patients aged ≥18 years with diabetes (n = 4994) who visited the study hospital once or more during 2004. Main Outcome Measures. The outcomes were mortality from the database of the Statistics Korea and end-stage renal disease (ESRD) incidence from ESRD registry in the Korean Society of Nephrology until December 2009. Results. Testing rates for blood pressure, eye examination, HbA1c, renal function and lipid profiles were 93.9, 32.8, 84.9, 33.5 and 45.9%, respectively. The percentage of patients achieving each treatment goal was 27.8% for blood pressure, 44.2% for HbA1c and 49.4% for low-density lipoprotein (LDL) cholesterol. There were 11.7% patients with composite outcome (death and/or ESRD). Male gender, level of HbA1c (<7%), presence of HbA1c data, checking eye examination, presence of data on urine albumin-to-creatinine ratio (UACR) and having anti-platelet medication were associated with better outcome. Conclusions. The adherence to recommendations was unsatisfactory, especially in checking eye examination, testing UACR and LDL cholesterol, and achieving a target goal for each parameter. Guideline adherence was positively related to better prognosis. Active strategies to apply the guidelines to clinical practice should be developed to improve patient outcomes. © The Author 2011. Published by Oxford University Press in association with the International Society for Quality in Health Care; All rights reserved.
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Oh, Se Won
Anam Hospital (Department of Nephrology and Hypertension, Anam Hospital)
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