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J Gen Intern Med. 2008 May;23(5):588-94. doi: 10.1007/s11606-008-0554-8. Epub 2008 Mar 4.

Why don't diabetes patients achieve recommended risk factor targets? Poor adherence versus lack of treatment intensification.

Author information

1
Division of Research, Kaiser Permanente Medical Care Program, Oakland, CA, USA. Julie.A.Schmittdiel@kp.org

Abstract

BACKGROUND:

Despite the availability of effective hypertension, hyperlipidemia, and hyperglycemia therapies, target levels of systolic blood pressure (SBP), LDL-cholesterol (LDL-c), and hemoglobin A1c control are often not achieved.

OBJECTIVE:

To examine the relative importance of patient medication nonadherence versus clinician lack of therapy intensification in explaining above target cardiovascular disease (CVD) risk factor levels.

DESIGN:

Cross-sectional assessment.

PARTICIPANTS:

In 2005, 161,697 Kaiser Permanente Northern California adult diabetes patients were included in the study.

MEASUREMENT:

"Above target" was defined as most recent A1c >/=7.0% for hyperglycemia, LDL-c >/=100 mg/dL for hyperlipidemia, and SBP >/=130 mmHg for hypertension. Poor adherence was defined as medication gaps for >/=20% of days covered for all medications for each condition separately. Treatment intensification was defined as an increase in the number of drug classes, increased dosage of a class, or a switch to a different class within the 3 months before or after notation of above target levels.

RESULTS:

Poor adherence was found in 20-23% of patients across the 3 conditions. No evidence of poor adherence with no treatment intensification was found in 30% of hyperglycemia patients, 47% of hyperlipidemia patients, and 36% of hypertension patients. Poor adherence or lack of therapy intensification was evident in 53-68% of patients above target levels across conditions.

CONCLUSIONS:

Both nonadherence and lack of treatment intensification occur frequently in patients above target for CVD risk factor levels; however, lack of therapy intensification was somewhat more common. Quality improvement efforts should focus on these modifiable barriers to CVD risk factor control.

PMID:
18317847
PMCID:
PMC2324158
DOI:
10.1007/s11606-008-0554-8
[Indexed for MEDLINE]
Free PMC Article

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