Reductions in diabetic cardiovascular risk by community primary care providers

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Reed, H. Lester ; Bernard, Elaine (2005)
  • Publisher: Co-Action Publishing
  • Journal: International Journal of Circumpolar Health (issn: 1797-237X, eissn: 1239-9736)
  • Related identifiers: doi: 10.3402/ijch.v64i1.17951
  • Subject: cardiovascular, community, Diabetic, medical group, multivariable

Objective. To evaluate a community-based, not-for-profit medical group’s effectiveness with diabetic management while using an electronic medical record and financial incentives. Design. Descriptive retrospective study over 2 years with published reference standards. Methods. There were 5,316 diabetic patients in the medical group (MG) compared with 5,069 diabetic patients reported in the literature (CT). The main outcome measures included serum hemoglobin A1C (HbA1C), total (TC), low density lipoprotein (LDL-C) and high density lipoprotein (HDL-C) cholesterol, and clinic measures of systolic (SBP) and diastolic blood pressure. We determined a mean 10-year composite multivariable cardiovascular risk score based upon these parameters. Results. The mean MG serum HbA1C (7.10±0.02; 8.18±0.23%), TC (193.2±0.64; 218.3±6.09 mg/dl), LDL-C (109.2±0.52; 137.8±4.24 mg/dl), and SBP (132.8±0.25; 141.6±2.36 mmHg) were below those for the CT (p<0.001). The MG mean overall coronary heart disease risk of 14.9±1.4% over 10 years was below that for the CT group of 22.7±2.3%, representing a 34.7±4.4% reduction (p<0.0002). The electronic medical record and the use of a financial award may have contributed to these results. Conclusion. Improvement of cardiovascular risk variables can be achieved in the primary care setting. Electronic tools and incentives may facilitate this improvement.(Int J Circumpolar Health 2005; 64(1):26-37)Keywords: cardiovascular, community, Diabetic, medical group, multivariable
  • References (29)
    29 references, page 1 of 3

    1. McGlynn EA, Asch SM, Adams, J, Keesey J, Hicks, J, Decristofaro A, Kerr EA.The quality of health care delivered to adults in the United States. NEJM 2003;348:2635-2645.

    2. George PB, Tobin KJ, Corpus RA, Devlin WH, O'Neill WW. Treatment of cardiac risk factors in diabetic patients: How well do we follow the guidelines? Am Heart J 2001;142(5):857-63.

    3. Schumacher C, Davidson M, Ehrsam G. Cardiovascular disease among Alaska Natives: a review of the literature. Int J Circumpolar Health 2003;62(4): 343-62.

    4. Naylor JL, Schraer CD. Diabetes among Alaska natives: a review. Int J Circumpolar Health 2003;62(4): 363-387

    5. Näyhä S. Cold and the risk of cardiovascular disease. A review. Int J Circumpolar Health 2002;61(4):373- 380.

    6. Gaede P, Vedel P, Larsen N, Jensen GVH, Paving H, Pederson O. Multifactorial intervention and cardiovascular disease in patients with type 2 diabetes. NEJM 2003;348:383-93.

    7. Collins R, Armitage CR, Sleight PS, Peto R. Heart Protection Study Collaborative Group. Heart protection study of cholesterol-lowering with simvastatin in 5963 people with diabetes: a randomized placebo-controlled trial. Lancet 2003;361(9374): 2000-16.

    8. UK Prospective Diabetes Study (UKPDS) Group. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes. (UKPDS 33). Lancet 1998;352:837-53

    9. Narayan KMV, Boyle JP, Thompson, TJ, Sorensen SW,Williamson DF. Lifetime risk for diabetes in the United States. JAMA 2003;290:1884-1890.

    10. Schmidt S, Burns C, Feller DB, Chang K, Hernandez B, McCarthy J, Burg MA. Evaluation of a quality improvement intervention for diabetes management. J for Healthcare Quality 2003;25(3):26-32.

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