Cardiovascular risk management and its impact in Australian general practice patients with type 2 diabetes in urban and rural areas

Abstract

Despite a number of national initiatives to improve general practice care and specifically support better care in rural areas, cardiovascular risk management and its impact in Australian general practice patients with type 2 diabetes was still suboptimal during the study period especially among patients from rural areas. Greater effort will be required to reduce the disparity in risk factor prevention for CVD between urban and rural people with type 2 diabetes in Australia.

Cardiovascular medication utilization and adherence among adults living in rural and urban areas: a systematic review and meta-analysis

“…The included studies were published over a 21-year time span (1990 to 2011) and had quality scores based on the STROBE checklist that ranged from 8.5 to 21 (median 17.5) out of a total of 22 possible items (0.5 points given for partial reporting). Two reports provided data on the same study [44,48], and six studies included data for more than one patient cohort [43,49,54,66,71,72]. Thus, 58 patient populations (or cohorts) were included in our study.…”

“…Exploring rural–urban differences was the primary objective of 18 studies (35%) [2,27,28,30,31,35,36,39,43,44,49,51,54,59,68,69,71,73]. Seven studies reported medication adherence (the proportion of doses taken as prescribed over a specific time period) or persistence (the length of continuous treatment) [76], and 47 reported outcomes related to medication utilization.…”

“…Overall, 16 studies included patient self-report, 31 studies included data from medical records or registries, and 5 studies were conducted using administrative databases. Nineteen studies reported crude utilization or adherence outcome data only [8,28,35-37,39,40,50,51,53,54,63,64,67,68,71,73-75]. …”

“…Forty seven (92%) studies [2,8,9,27-36,38-47,49,51-69,71-73,75] evaluated cardiovascular medication utilization with 20 (39%) studies specifically evaluating utilization of ASA or other anti-thrombotic agents, 34 (67%) evaluating antihypertensive use, and 11 (22%) evaluating the use of lipid lowering agents (Additional file 1: Table S3). Substantial variation in the use of cardiovascular medications was observed between studies and between rural versus urban sub-populations within each study.…”

“…Indeed, the absolute difference in the utilization of cardiovascular medications ranged from -46% to +4% in rural versus urban patients for ASA or other anti-thrombotic drugs, -37% to +25% for antihypertensive drugs, and -45% to +8% for lipid lowering agents. Of the 47 studies that evaluated cardiovascular medication use, sufficient data for pooling were available in 34 studies (39 separate cohorts as two cohorts were included in three studies [43,66,72] and three cohorts in one study [71]). In the unadjusted pooled analyses (23 studies) [27-29,35,36,38,39,41,43,44,46,47,51,53,55-58,64,68,71,73,75], patients in rural areas with cardiovascular disease or diabetes were less likely to receive evidence-based cardiovascular drug therapy compared to urban residents (pooled unadjusted OR 0.88, 95% CI 0.79, 0.98, p = 0.02; I 2  = 97%) (Table 1).…”