Effects of an Automated Electronic Reminder in Changing the Antiplatelet Drug–Prescribing Behavior Among Italian General Practitioners in Diabetic Patients

Filippi, Alessandro; Sabatini, Andrea; Badioli, Letizia; Samani, Fabio; Mazzaglia, Giampiero; Catapano, Alberico L.; Cricelli, Claudio

doi:10.2337/diacare.26.5.1497

Cited by 86 publications

(94 citation statements)

References 20 publications

(14 reference statements)

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“…Despite this, according to our data, X2 additional antihypertensive drugs could be necessary to aim to the target BP recommended for high-CV risk patients; 3 this is a relevant effort for patients, GPs, and National Health Services. Computer-based strategies [21][22] could be a useful tool both to identify the high-risk patients and to remind the GP to increase the antihypertensive therapy (and to check patient compliance).…”

Section: Discussionmentioning

confidence: 99%

Blood pressure control and drug therapy in patients with diagnosed hypertension: a survey in Italian general practice

Filippi

Paolini

Innocenti³

et al. 2009

J Hum Hypertens

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Blood pressure (BP) control remains unsatisfactory worldwide. Better knowledge of BP management in clinical practice is needed to develop more effective improving strategies. Using a large Italian primary care database, we selected the subjects diagnosed with hypertension, and extracted the diagnosis of myocardial infarction, angina pectoris/coronary disease, stroke/transitory ischemic attack (TIA), heart failure, atrial fibrillation, peripheral arterial disease, diabetes mellitus, the serum total cholesterol, HDL cholesterol, triglycerides, creatinine, BP, electrocardiogram, weight, height and the prescription of cardiovascular (CV)

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Section: Discussionmentioning

confidence: 99%

Blood pressure control and drug therapy in patients with diagnosed hypertension: a survey in Italian general practice

Filippi

Paolini

Innocenti³

et al. 2009

J Hum Hypertens

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“…Completeness and accuracy of information are assessed by running a set of queries (quality indicators) used to generate a composite score ranging from 0-1. Only physicians (n=700) reaching a composite quality score.0.7 were included in epidemiologic studies (12,13), and the validity of the data has been previously shown (14)(15)(16).…”

Section: Methodsmentioning

confidence: 99%

Risk of ESRD and Death in Patients with CKD Not Referred to a Nephrologist

Minutolo

Lapi

Chiodini

et al. 2014

Clinical Journal of the American Society of Nephrology

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Background and objectives Rising prevalence of CKD requires active involvement of general practitioners to limit ESRD and mortality risk. However, the outcomes of patients with CKD exclusively managed by general practitioners are ill defined. Results Overall 64% of patients were in stage 3a, and 4.5% of patients were in stages 3b-5. Patients with stages 1 and 2 were younger, were predominantly men, more frequently had diabetes, and had lower prevalence of previous cardiovascular disease than patients with stages 3a-5. Hypertension was frequent in all CKD stages (80%-94%), whereas there was a lower prevalence of dyslipidemia, albuminuria, and obesity associated with more advanced CKD. During the follow-up (median=7.2 years; interquartile range=4.7-7.7), 6592 patients died and 295 started ESRD. Compared with stages 1 and 2 (reference), mortality risk (hazard ratio, 95% confidence interval) was higher in stages 3b-5 (1.66, 1.49-1.86, 2.75, 2.41-3.13 and 2.54, 2.01-3.22, respectively) but not stage 3a (1.11, 0.99-1.23). Similarly, ESRD risk (hazard ratio, 95% confidence interval) was not higher at stage 3a (1.44, 0.79-2.64) but was greater in stages 3b-5 (11.0, 6.3-19.5, 91.2, 53.2-156.2 and, 122.8, 67.9-222.0, respectively). Among modifiable risk factors, anemia and albuminuria significantly predicted either outcome, whereas hypertension only predicted mortality.Conclusions In patients with CKD not referred to nephrology, risks of ESRD and mortality were higher in those with CKD stages 3b-5.

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“…In this regard, we believe that the emphasis should be on changing provider behavior (25,26,(32)(33)(34)(35)(36)(37)(38)(39)(40)43). Our strategy was based on previous surveys that indicated that the residents were familiar with glycemic goals (58) and diabetes medications but often failed to intensify therapy when glucose levels were high (28).…”

Section: A1c Outcomes In the Intervention Site Versus Other Primary Cmentioning

confidence: 99%

An Endocrinologist-Supported Intervention Aimed at Providers Improves Diabetes Management in a Primary Care Site

et al. 2005

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OBJECTIVE -Management of diabetes is frequently suboptimal in primary care settings, where providers often fail to intensify therapy when glucose levels are high, a problem known as clinical inertia. We asked whether interventions targeting clinical inertia can improve outcomes. RESEARCH DESIGN AND METHODS -A controlled trial over a 3-year period was conducted in a municipal hospital primary care clinic in a large academic medical center. We studied all patients (4,138) with type 2 diabetes who were seen in continuity clinics by 345 internal medicine residents and were randomized to be control subjects or to receive one of three interventions. Instead of consultative advice, the interventions were hard copy computerized reminders that provided patient-specific recommendations for management at the time of each patient's visit, individual face-to-face feedback on performance for 5 min every 2 weeks, or both.RESULTS -Over an average patient follow-up of 15 months within the intervention site, improvements in and final HbA 1c (A1C) with feedback ϩ reminders (⌬A1C 0.6%, final A1C 7.46%) were significantly better than control (⌬A1C 0.2%, final A1C 7.84%, P Ͻ 0.02); changes were smaller with feedback only and reminders only (P ϭ NS vs. control). Trends were similar but not significant with systolic blood pressure (sBP) and LDL cholesterol. Multivariable analysis showed that the feedback intervention independently facilitated attainment of American Diabetes Association goals for both A1C and sBP. Over a 2-year period, overall glycemic control improved in the intervention site but did not change in other primary care sites (final A1C 7.5 vs. 8.2%, P Ͻ 0.001).CONCLUSIONS -Feedback on performance aimed at overcoming clinical inertia and given to internal medicine resident primary care providers improves glycemic control. Partnering generalists with diabetes specialists may be important to enhance diabetes management in other primary care settings. Diabetes Care 28:2352-2360, 2005T ype 2 diabetes is a public health pandemic with devastating impact on morbidity, mortality, and cost. In the U.S., the prevalence of diabetes increased from 4.9% of the population in 1990 to 7.9% in 2001 (1-4), and prevalence is projected to rise to 30 million Americans in 2030 (5). The lifetime risk of diabetes is currently projected at 33 and 38% for American men and women, respectively, born in 2000 (6), with accompanying decrease in life expectancy (6 -8). Diabetes increases the risk of both microvascular (9,10) and macrovascular disease (11), and diabetes is now the sixth leading cause of death in the U.S (12). Diabetes accounted for ϳ11% of total U.S. health care expenditures in 2002 ($92 billion) (13), but better metabolic control can reduce costs (14).Most diabetes management in the U.S. takes place in primary care settings, where measures of both process and outcome indicate that care is often suboptimal. Surveys in the early 1990s revealed that many Medicare beneficiaries had limited evaluation of levels of HbA 1c (A1C), cholesterol, o...

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Effects of an Automated Electronic Reminder in Changing the Antiplatelet Drug–Prescribing Behavior Among Italian General Practitioners in Diabetic Patients

Cited by 86 publications

References 20 publications

Blood pressure control and drug therapy in patients with diagnosed hypertension: a survey in Italian general practice

Blood pressure control and drug therapy in patients with diagnosed hypertension: a survey in Italian general practice

Risk of ESRD and Death in Patients with CKD Not Referred to a Nephrologist

An Endocrinologist-Supported Intervention Aimed at Providers Improves Diabetes Management in a Primary Care Site

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