NDLI: Impact of the diabetes Canada guideline dissemination strategy on dispensed vascular protective medications for older patients in Ontario, Canada: a linked EMR and administrative data study

Content Provider	Springer Nature : BioMed Central
Author	Greiver, Michelle Kalia, Sumeet Moineddin, Rahim Chen, Simon Duchen, Raquel Rigobon, Alanna
Abstract	Background The 2013 Diabetes Canada guidelines recommended routinely using vascular protective medications for most patients with diabetes. These medications included statins and angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs). Antiplatelet agents were only recommended for secondary prevention of cardiovascular disease. Using Electronic Medical Record (EMR) data, we previously found that guideline dissemination efforts were not associated with an increase in the rate of primary care prescriptions of these medications. However, this needs confirmation: patients can receive prescriptions from different sources including specialists and they may not always fill these prescriptions. Using both EMR and administrative health data, we examined whether guideline dissemination impacted the dispensing of vascular protective medications to patients. Methods The study population included patients with diabetes aged 66 or over in Ontario, Canada. We created two cohorts using two different approaches: an Electronic Medical Record (EMR) algorithm for diabetes using linked EMR-administrative data and an administrative algorithm using population level administrative data. We examined data from January 2010 to December 2016. Patients with diabetes were deemed to be likely taking a medication (or covered) during a quarter if the daily amount for a dispensed medication would last for at least 75% of days in any given quarter. An interrupted time series analysis was used to assess the proportion of patients covered by each medication class. Proton pump inhibitors (PPIs) were used as a reference. Results There was no increase in the rate of change for medication coverage following guideline release in either the EMR or the administrative diabetes cohorts. For statins, the change in trend was − 0.03, p = 0.7 (EMR) and − 0.12, p = 0.04(administrative). For ACEI/ARBs, this was 0.03, p = 0.6 (EMR) and 0, p = 1(administrative). For antiplatelets, this was 0.001, P = .97 (EMR) and − 0.03, p = 0.03 (administrative). The comparator PPI was − 0.07, p = 0.4 (EMR) and − 0.11, p = 0.002 (administrative). Conclusions Using both EMR and administrative health data, we confirmed that the Diabetes Canada 2013 guideline dissemination strategy did not lead to an increased rate of coverage for vascular protective medications. Alternative strategies are needed to effect change in practice.
Related Links	https://bmchealthservres.biomedcentral.com/counter/pdf/10.1186/s12913-020-05232-3.pdf
Ending Page	11
Page Count	11
Starting Page	1
File Format	HTM / HTML
ISSN	14726963
DOI	10.1186/s12913-020-05232-3
Journal	BMC Health Services Research
Issue Number	1
Volume Number	20
Language	English
Publisher	BioMed Central
Publisher Date	2020-05-01
Access Restriction	Open
Subject Keyword	Public Health Health Administration Health Informatics Nursing Research Guideline adherence Drug utilization Diabetes mellitus Primary health care Electronic health records Cardiovascular diseases/prevention & control
Content Type	Text
Resource Type	Article
Subject	Health Policy

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