HSR&D Citation Abstract
Search | Search by Center | Search by Source | Keywords in Title
Adoption of New Pharmacotherapy Recommendations for Type 2 Diabetes: The Effect of Shared Care
Pugh M, Pogach L, Berlowitz D. Adoption of New Pharmacotherapy Recommendations for Type 2 Diabetes: The Effect of Shared Care. Paper presented at: AcademyHealth Annual Research Meeting; 2002 Jun 24; Washington, DC.
Research Objective:Research suggests that multi-medication regimes are better able to maintain glycemic control for many type 2 diabetics when sulfonylurea mono-therapy is no longer effective. This is critical since improved glycemic control (HbA1c < 7%) has been associated with decreased risk of complications, utilization, and cost. Veteran's Health Administration (VHA) clinical guidelines recommend instituting these multi-medication regimes when single drug regimens no longer provide adequate glycemic control. We examine the extent to which recommended regimes are being adopted within the VHA and to see if patients who receive care from both generalists and specialists are more likely to receive recommended regimes. Study Design:Data were collected from VA pharmacy, laboratory, and administrative data. Medication data were used to determine which medications each patient was on from Fiscal Year (FY) 1997-1999. Medication regimes were classified as traditional (insulin and sulfonylurea mono-therapies) and newer (metformin mono-therapy, multiple oral medications, insulin and oral medications, new hypo-glycemic drugs) for each year. Inpatient and outpatient data from FY97-FY99 included demographics (sex, race, age), diagnoses, and clinics visited. Type of care was classified as primary care only and shared care (patients also seen by a diabetes specialist). Diagnoses were used to determine if diabetes complications were present. Logistic regression with GEE analysis was used to determine if patients received recommended regimes (0,1) over time. Age, gender, race, geographic location, and disease severity were controlled. Population Studied:Veterans from New England and Florida-Puerto Rico who were diagnosed with diabetes and were also on hypoglycemic medications (N = 20,639). Principal Findings:Analyses indicated that all patients were more likely to receive recommended regimes in 1999 than 1997 (OR: 1.62-1.70). Patients having shared care were more likely than patients seen only in primary care (OR: 1.13-1.26) to receive recommended regimes. Further, there were geographic differences with patients from Florida-Puerto Rico being more likely to receive recommended regimes than patients from New England(OR: 1.19-1.28). Further examination using bivariate analyses indicated that geographical differences were partly explained by more frequent use of shared care in Florida-Puerto Rico.Conclusions:Adoption of recommended regimes was evident from 1997 to 1999, and patients with shared care were most likely to receive them. Geographic variation was also associated with differential use of shared care.Implications for Policy, Delivery or Practice:Shared care may promote adoption of new clinical recommendations. Overall patterns indicated delays in adoption by primary care providers. Since diabetes care is increasingly to be provided by generalists, methods of disseminating new information to them are critical.