Adherence to clinical guidelines in management of diabetes and prevention of cardiovascular disease in Qatar

Abstract

The prevalence of diabetes mellitus (DM) in the UK increased in 2009 to 4 %, of which type-2 diabetes accounts for 85-95 % of all cases. In Qatar the prevalence of DM among the adult Qatari population in 2008 was 16.7 %; around four times higher than the prevalence in the UK. The aim of the study was to design and to apply a medication assessment tool (MAT) to determine the level of adherence to internationally recognised guideline recommendations in type-2 diabetes management and in primary prevention of cardiovascular disease (CVD) among type-2 diabetes patients, to quantify any gaps in guideline implementation. 305 patients were included in this study; all diagnosed with type-2 diabetes with no history of CVD. A 38 criteria MAT was designed from published guideline recommendations on the management of type-2 diabetes and combined with recommendations relevant to primary prevention of cardiovascular disease. The MAT comprised 21 criteria assessing control of blood glucose, 5 criteria assessing management of diabetes complications and 12 criteria assessing preventive medication use in CVD. The MAT was validated by a group of practitioners and researchers and field tested in the diabetes outpatient clinic within Hamad General Hospital, Qatar, with electronic and manual access to patients' medical records. Levels of applicability and adherence to each criterion were calculated individually and the overall adherence was determined. The MAT was applied to the whole study sample (11,590 assessed criteria in 305 patients). Application of the MAT identified 19/38 criteria with high levels of adherence (≥80 %), 9/38 criteria with intermediate levels of adherence (≥50 %; <80 %) and 10/38 criteria with low levels of adherence (<50 %). The overall adherence in 305 patients was 68.1 % (95 % CI: 67, 69) in 6,657 applicable criteria. Total non-adherences, both justified and unjustified, were found in 30.8 % (95 % CI: 30, 32) in 2,049 of the applicable criteria in which only 5.8 % (95 % CI: 5, 7) in 118 criteria had a documented justification. Consequently 94.2 % of all non-adherences (95 % CI: 93, 95) in 1,931 criteria had unjustified non-adherence and indicated a need for inclusion in treatment review through an appropriate pharmaceutical care plan. The study identifies levels of adherence to guideline recommendations, the need for additional documentation and criteria with low adherence that might be a focus for an educational intervention and a starting point for targeted pharmaceutical care.