Quality of prescribing: A study of guideline adherence of medication in patients with diabetes mellitus

Abstract

This study aimed to evaluate the quality of prescribing of cardiovascular medication by a criterion-based approach with reference to national treatment guidelines for the care of patients with diabetes mellitus. Case notes and database records of diabetic outpatients (age range 15-75 years) managed in a secondary care clinic of a major teaching hospital were reviewed and 23 criteria in a previously evaluated tool were applied to determine adherence to guidelines. For the 214 study patients (57.5% male, 69.6% type 2 diabetes mellitus), mean (SD) age was 52.2 (16.3) years and mean (SD) BMI was 30.3 (6.6) kg/ m2. Overall guideline adherence was 74.0% (95% CI: 71.2, 76.8). Excluding criteria that were only applicable to less than 10% of the total study group, the three criteria with the highest adherence were 'use of metformin in overweight patients': 95.1% (91.0, 99.3), 'use of statin in primary prevention of CHD': 94.3% (88.8, 99.7) and 'use of aspirin in secondary prevention of CHD': 93.8% (85.4, 100). Similarly, the three criteria with the lowest adherence were 'achievement of target blood pressure in patients on antihypertensives': 43.4% (34.2, 52.5), 'use of aspirin in primary prevention of CHD': 51.2% (35.9, 66.5) and 'use of ACE inhibitor in patients with defined risk factors': 54.8% (44.7, 65.0). Among the overall level of non-adherence (26.0% of total applicable criteria) the proportion of criteria in which non-adherence was 'justified' by the prescriber was 9.2% (7.4, 11.0), and the 'unjustified' proportion was 16.8% (14.4, 19.2). In conclusion, overall adherence to criteria was relatively high. Targets for improving prescribing practice in this diabetic population were identified from apparent low-adherence criteria and from the overall need to improve documentation of prescribing decisions. Copyright © 2005 John Wiley & Sons, Ltd.