ADHERENCE TO DIABETES MELLITUS TREATMENT GUIDELINES FROM THEORY TO PRACTICE: THE MISSING LINK

Authors

  • Noreen Rahat Hashmi Rahbar medical and dental college lahoe
  • Shahzad Ali Khan

Abstract

Diabetes mellitus is a complex multisystem disease that requires high quality care. Clinical practice guidelines help physicians and patients make the best possible health care decisions and improve health care management of diabetic patients. These guidelines provide the norms for clinical management as well as monitoring of diabetes care. They are not simple algorithms but are based on structured evidence based diabetic management protocols developed from randomized controlled trials. Despite the widespread availability of these diabetic guideline, their use is suboptimal at best. There are several factors blamed for contributing to this missing link from available theoretical guideline recommendations to practical applications of these guidelines. We present a brief review based on available literature review for an ongoing interventional study being done by authors in two tertiary care hospital in Lahore Pakistan for improving adherence to diabetes guidelines. We will discuss guideline implementation cycle and also present a framework encompassing various factors involved in adherence to guidelines. Until recently the emphasis to improve the guideline adherence targeted the factors relating to individual health care professionals in reference to their knowledge, attitude practice of the guidelines. However, we will discuss that broader range of health care systems, organizational factors, and factors relating to patients which may also significantly impact the adherence to the guidelines. The framework emphasises that it is important to understand the factors that act as barriers and contribute to the missing link between theory and practice of diabetic guidelines. This will help plan appropriate strategies in the pre-implementation stage for effective and improved diabetes guidelines adherence and management.Keywords: Diabetes mellitus; Diabetes management; Diabetic guidelines; Adherence to guidelines

Author Biography

Noreen Rahat Hashmi, Rahbar medical and dental college lahoe

Professor/ Head of Department Community Medicine

References

World Health Organization, International Diabetes Federation. Definition and diagnosis of diabetes mellitus and intermediate hyperglycaemia: report of a WHO/IDF consultation [Internet]. 2006 [cited 2016 jun 17]. Available from: http://apps.who.int/iris/bitstream/10665/43588/1/9241594934_eng.pdf?ua=1

Lozano R, Naghavi M, Foreman K, Lim S, Shibuya K, Aboyans V, et al. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 2012;380(9859):2095–128.

International Diabetes Federation (IDF) [Internet]. Country estimates table 2011. IDF diabetes atlas. 6th ed. 2012. Available from: http://www.idf.org/sites/default/files/EN_6E_Atlas_Full_0.pdf [accessed 17 June 2016]

Chen L, Magliano DJ, Zimmet PZ. The worldwide epidemiology of type 2 diabetes mellitus--present and future perspectives. Nat Rev Endocrinol 2011;8(4):228–36.

Organisation mondiale de la santé. Global status report on noncommunicable diseases 2014: attaining the nine global noncommunicable diseases targets; a shared responsibility. Geneva: World Health Organization; 2014.

Nanditha A, Ma RC, Ramachandran A, Snehalatha C, Chan JC, Chia KS, Shaw JE, Zimmet PZ. Diabetes in Asia and the Pacific: Implications for the global epidemic. Diabetes Care. 2016;39(3):472–85.

Whiting DR, Guariguata L, Weil C Shaw J. IDF Diabetes Atlas: Global estimates of the prevalence of diabetes for 2011 and 2030. Diabetes Res Clin Pract 2011;94(3):311–21.

Pakistan. International Diabetes Federation [Internet]. [cited 2016 jun 15]. Available from: http://www.idf.org/membership/mena/pakistan

UK Prospective Diabetes Study (UKPDS) Group. Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes UKPDS 38. BMJ 1998;317(7160):703–13.

Clark CM Jr, Snyder JW, Meek RL, Stutz LM, Parkin CG. A systematic approach to risk stratification and intervention within a managed care environment improves diabetes outcome and patient satisfaction. Diabetes Care 2001;24(6):1079–86.

American Diabetes Association. Standards of medical care in diabetes--2014. Diabetes Care 2014;37(Suppl 1):S14–80.

IDF Clinical Guidelines Task Force. Global Guideline for Type 2 Diabetes: recommendations for standard, comprehensive, and minimal care. Diabet Med 2006;23(6):579–93.

WHO, editor. Prevention and control of noncommunicable diseases: guidelines for primary health care in low resource settings. Geneva (Switzerland): World Health Organization; 2012.

Goldfracht M, Porath A. Nationwide program for improving the care of diabetic patients in Israeli primary care centers. Diabetes Care 2000;23(4):495–499.

Kirkman MS, Williams SR, Caffrey HH, Marrero DG. Impact of a program to improve adherence to diabetes guidelines by primary care physicians. Diabetes Care 2002;25(11):1946–51.

Gross R, Tabenkin H, Porath A, Heymann A, Greenstein M, Porter B, et al. The relationship between primary care physicians’ adherence to guidelines for the treatment of diabetes and patient satisfaction: findings from a pilot study. Fam Pract 2003;20(5):563–9.

National Health and Medical Research Council (Australia). A guide to the development, implementation and evaluation of clinical practice guidelines. Canberra: National Health and Medical Research Council; 1999.

Leach MJ, Segal L. Are clinical practical guidelines (CPGs) useful for health services and health workforce planning? A critique of diabetes CPGs. Diabetic Med 2010;27(5):570–7.

Peyrot M, Rubin RR, Lauritzen T, Snoek FJ, Matthews DR, Skovlund SE. Psychosocial problems and barriers to improved diabetes management: results of the Cross‐National Diabetes Attitudes, Wishes and Needs (DAWN) Study. Diabetic Med 2005;22(10):1379–85.

Stark Casagrande S, Fradkin JE, Saydah SH, Rust KF, Cowie CC. The prevalence of meeting A1C, blood pressure, and LDL goals among people with diabetes, 1988–2010. Diabetes Care 2013;36(8):2271–9.

Elis A, Rosenmann L, Chodick G, Heymann AD, Kokia E, Shalev V. The association between glycemic, lipids and blood pressure control among Israeli diabetic patients. QJM 2008;101(4):275–80.

Clancy DE, Cope DW, Magruder KM, Huang P, Wolfman TE. Evaluating concordance to American Diabetes Association standards of care for type 2 diabetes through group visits in an uninsured or inadequately insured patient population. Diabetes Care 2003;26(7):2032–6.

Muzaffar F, Fatima N, Fawwad A, Riaz M. Adherence of healthcare professionals to American Diabetes Association 2004 guidelines for the care of patients with type 2 diabetes at peripheral diabetes clinics in Karachi, Pakistan. Pak J Med Sci 2013;29(2):474–8.

Chaudhry RA, Khan AM, Mahmood A. Diabetics and their Diseases, What do they know? Assessing Knowledge Level among Diabetic Patients [Internet]. [cited 2016 Jun 17]. Available from: http://www.medforum.pk/index.php/article-database/9-articles/35-

Grol RP, Bosch MC, Hulscher ME, Eccles MP, Wensing M. Planning and studying improvement in patient care: the use of theoretical perspectives. Milbank Q 2007;85(1):93–138.

Gagliardi AR, Brouwers MC, Palda VA, Lemieux-Charles L, Grimshaw JM. How can we improve guideline use? A conceptual framework of implementability. Implement Sci 2011;6:26.

Shortell SM, Jones RH, Rademaker AW, Gillies RR, Dranove DS, Hughes EF, et al. Assessing the impact of total quality management and organizational culture on multiple outcomes of care for coronary artery bypass graft surgery patients. Med Care 2000;38(2):207–17.

Graham ID, Logan J, Harrison MB, Straus SE, Tetroe J, Caswell W, et al. Lost in knowledge translation: time for a map?. J Contin Educ Health Prof 2006;26(1):13–24.

Burgers JS, Grol R, Klazinga NS, Mäkelä M, Zaat J. Towards evidence-based clinical practice: an international survey of 18 clinical guideline programs. Int J Qual Health Care 2003;15(1):31–45.

Seidu S, Khunti K. Non-adherence to diabetes guidelines in primary care - the enemy of evidence-based practice. Diabetes Res Clin Pract 2012;95(3):301–2.

Rothwell PM. External validity of randomised controlled trials: "To whom do the results of this trial apply?". Lancet 2005;365(9456):82–93.

Ackermann SP, Cheal N. Factors affecting physician adherence to breast cancer screening guidelines. J Cancer Educ 1994;9(2):96–100.

Dijkstra RF, Braspenning JC, Uiters E, van Ballegooie E, Grol RP. Perceived Barriers to the Implementation of Diabetes Guidelines in Hospitals in the Netherlands. Neth J Med 2000;56(3):80–5.

Drass J, Kell S, Osborn M, Bausell B, Corcoran J Jr, Moskowitz A, et al. Diabetes care for Medicare beneficiaries: attitudes and behaviors of primary care physicians. Diabetes Care 1998;21(8):1282–7.

Tunis SR, Hayward RS, Wilson MC, Rubin HR, Bass EB, Johnston M, et al. Internists' attitudes about clinical practice guidelines. Ann Intern Med 1994;120(11):956–63.

Litzelman DK, Tierney WM. Physicians’ reasons for failing to comply with computerized preventive care guidelines. J Gen Intern Med 1996;11(8):497–9.

Brown JB, Harris SB, Webster-Bogaert S, Wetmore S, Faulds C, Stewart M. The role of patient, physician and systemic factors in the management of type 2 diabetes mellitus. Fam Pract 2002;19(4):344–9.

Fürthauer J, Flamm M, Sönnichsen A. Patient and physician related factors of adherence to evidence based guidelines in diabetes mellitus type 2, cardiovascular disease and prevention: a cross sectional study. BMC Fam Pract 2013;14:47.

Grimshaw JM, Russell IT. Effect of clinical guidelines on medical practice: a systematic review of rigorous evaluations. Lancet 1993;342(8883):1317–22.

Farquhar CM, Kofa EW, Slutsky JR. Clinicians' attitudes to clinical practice guidelines: a systematic review. Med J Aust 2002;177(9):502–6.

Grol R, Wensing M. What drives change? Barriers to and incentives for achieving evidence-based practice. Med J Aust 2004;180(6 Suppl):S57–60.

Kurtz SM. Adherence to diabetes regimens: empirical status and clinical applications. Diabetes Educ 1990;16(1):50–9.

Marrero DG. Changing patient behavior. Endocr Pract 2006;12(Suppl 1):118–20.

Delamater AM. Improving patient adherence. Clin Diabetes 2006;24(2):71–7.

Delamater AM, Jacobson AM, Anderson B, Cox D, Fisher L, Lustman P, et al. Psychosocial therapies in diabetes report of the psychosocial therapies working group. Diabetes Care 2001;24(7):1286–92.

Peyrot M, McMurry Jr JF, Kruger DF. A biopsychosocial model of glycemic control in diabetes: stress, coping and regimen adherence. J Health Soc Behav 1999;40(2):141–58.

Brownlee-Duffeck M, Peterson L, Simonds JF, Goldstein D, Kilo C, Hoette S. The role of health beliefs in the regimen adherence and metabolic control of adolescents and adults with diabetes mellitus. J Consult Clin Psychol 1987;55(2):139–44.

Funnell MM. The diabetes attitudes, wishes, and needs (DAWN) study. Clin Diabetes 2006;24(4):154–5.

Ciechanowski PS, Katon WJ, Russo JE, Walker EA. The patient-provider relationship: attachment theory and adherence to treatment in diabetes. Am J Psychiatry 2001;158(1):29–35.

TRIAD Study Group. Health Systems, Patients Factors, and Quality of Care for Diabetes A synthesis of findings from the TRIAD Study. Diabetes Care 2010;33(4):940–7.

Grumbach K, Bodenheimer T. Can health care teams improve primary care practice? JAMA 2004;291(10):1246–51.

Published

2016-12-01