Audit Of Type 2 Diabetes Management And Quality Use Of Medicines In The Australian Primary Care Setting
Objectives: National guidelines , National Prescribing Service recommendations and the Diabetes Annual Cycle of Care clearly outline quality standards for the management of patients with type 2 diabetes mellitus (T2DM). We sought to determine the prevalence of treated T2DM and the use of medicines to treat T2DM in the Australian primary care setting through the conduct of an audit and to determine the level of control on current therapy as indicated by HbA1c measurements. An audit service entitled 'Treatment Optimisation Program & Diabetes Review' was designed to facilitate the identification of treated patients with type 2 diabetes mellitus, current medicines, the level of glycaemic control and the existence of a Diabetes Annual Cycle of Care.
Methods: An audit service was developed to support the objectives outlined. The Treatment Optimisation Program and Diabetes Review audit service was launched nationally in June 2004 and was redesigned in January 2005 to incorporate Annual Cycle of Care reviews. Aggregated, de-identified summary data was collected for approximately 30 weeks from January 2005 through June 2005. The audit was designed to be executed by a professional team of registered nurses and diabetes nurse educators throughout Australia. The nurse educator completed a report for each general practitioner including the total number of patients with treated type 2 diabetes, current medications, the proportion of patients that had an HbA1c measured, the proportion of patients that had an HbA1c > 7%, and the number of patients that had an Annual Cycle of Care initiated. A report for each patient with HbA1c >7% was completed for the treating general practitioner. The report informed patient's name, date of birth, most recent HbA1c results, when the patient was last seen, whether a recall had been scheduled, current medication regimen, whether an Annual Cycle of Care had been initiated and a summary as identified from general practitioner progress comments. In addition, for patients that did not have an Annual Cycle of Care initiated, the nurse educator completed a report identifying the care required as part of the plan, ie, a foot check, education about lifestyle modification or an HbA1c measurement.
Results: During the period of data collection between January and June 2005 inclusive, a total of 449 general practitioners participated in the audit service. The general practitioners had an average of 56 treated patients with type 2 diabetes mellitus and 27% of these patients had no HbA1c measurement available. Of the 73% that did have an HbA1c measure available for review, more than 51% were sub-optimally controlled with an HbA1c >7% and more than half of these patients were on combination metformin and sulfonylurea.
Conclusions: The Treatment Optimisation Program & Diabetes Review audit service revealed that approximately 51% of patients with type 2 diabetes, treated with oral hypoglycaemic agents and/or insulin with an HbA1c recorded, are sub-optimally controlled, i.e., HbA1c >7%, despite national diabetes guidelines and the availability of the new glitazones. The sub-optimally controlled patients on combination oral hypoglycaemic agents and/or insulin may benefit from titration of current therapies and the addition of or substitution with a glitazone. When consideration is given to the number of patients who had been prescribed a glitazone (705) compared to potential number of patients that may benefit from a glitazone (6,616), it highlights complexities with prescribing this type of agent within PBS guidelines.
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National Prescribing Service RADAR. April 2005.
Department of Health and Ageing Medicare Benefits Schedule. November 1, 2005.