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Int J Qual Health Care. 2011 Aug;23(4):413-9. doi: 10.1093/intqhc/mzr036. Epub 2011 Jun 25.

Adherence to clinical practice guidelines and outcomes in diabetic patients.

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1
Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.

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.

PMID:
21705772
DOI:
10.1093/intqhc/mzr036
[Indexed for MEDLINE]
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