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Vlacho B, Mata-Cases M, Fernandez-Camins B, Romera Liébana L, Barrot-de la Puente J, Franch-Nadal J. Adherence to the therapeutic guidelines recommendations among the people with type 2 diabetes mellitus and obesity, frailty, or recent diagnosis, attended in primary health care centers in Spain: A cross-sectional study. Front Med (Lausanne) 2023; 10:1138956. [PMID: 37035300 PMCID: PMC10080116 DOI: 10.3389/fmed.2023.1138956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 03/10/2023] [Indexed: 04/11/2023] Open
Abstract
Introduction Clinical practice guidelines are helpful for clinicians, and their proper implementation could improve the quality of care and management of participants with diabetes. This study aimed to evaluate the degree of adherence to the Clinical Practice Guidelines (CPG) recommendations among obese, frail, or recently diagnosed type 2 diabetes mellitus (T2DM) participants in primary care centers in Spain. Methods We perform a cross-sectional study on a national level in two phases. In the first phase, study participants were recruited, and their clinical data were collected. In the second phase, data related to the participating physicians were collected. Results In total, 882 participants from 240 physicians were analyzed. According to the study questionnaire, most participants from all three clinical groups had adequate adherence to the CPG. This percentage was highest among the recently diagnosed T2DM (91.6%) and lowest percent of frail T2DM persons (74.7%). The inadequate adherence to the guidelines was observed mainly among the obese and frail participants with T2DM from medical doctors with low CPG knowledge (3.4% and 3.5%, respectively). Regarding the patient's characteristics and degree of adherence to the guidelines, the participants with inadequate adherence were generally older, with higher BMI, poorer HbA1c control, and fewer visits with primary care physicians. Most (57%) primary care physicians had moderate CPG knowledge. In our multivariable logistic model, we did not observe statistically significant odds ratios for different characteristics related to the physicians/consultation and low CPG knowledge. Discussion The results of our cross-sectional study observe adequate adherence to the clinical guidelines by the primary care physicians for the majority of the participants with obesity, frailty, or newly diagnosed with T2DM.
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Affiliation(s)
- Bogdan Vlacho
- DAP-Cat Group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- Institut de Recerca Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- CIBER of Diabetes and Associated Metabolic Diseases (CIBERDEM, ID CB15/00071), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain
| | - Manel Mata-Cases
- DAP-Cat Group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- CIBER of Diabetes and Associated Metabolic Diseases (CIBERDEM, ID CB15/00071), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain
- Primary Health Care Center La Mina, Gerència d'Àmbit d'Atenció Primària Barcelona Ciutat, Institut Català de la Salut, Sant Adrià de Besòs, Spain
| | - Berta Fernandez-Camins
- DAP-Cat Group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- Primary Health Care Center Poblenou, Gerència d'Àmbit d'Atenció Primària Barcelona Ciutat, Institut Català de la Salut, Sant Adrià de Besòs, Spain
| | - Laura Romera Liébana
- DAP-Cat Group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- Primary Health Care Center Doctor Lluís Sayé, Gerència d'Àmbit d'Atenció Primària Barcelona Ciutat, Institut Català de la Salut, Barcelona, Spain
| | - Joan Barrot-de la Puente
- DAP-Cat Group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- Center d'Atenció Primària Salt, Gerència d'Àmbit d'Atenció Primaria, Institut Català de la Salut, Girona, Spain
| | - Josep Franch-Nadal
- DAP-Cat Group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- CIBER of Diabetes and Associated Metabolic Diseases (CIBERDEM, ID CB15/00071), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain
- Primary Health Care Center Raval Sud, Gerència d'Àmbit d'Atenció Primària Barcelona Ciutat, Institut Català de la Salut, Barcelona, Spain
- *Correspondence: Josep Franch-Nadal
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Gimeno JA, Cánovas G, Durán A. Factors Associated with Adherence to Clinical Practice Guidelines for Patients with Type 2 Diabetes Mellitus: Results of a Spanish Delphi Consensus. J Diabetes Res 2021; 2021:9970859. [PMID: 34725642 PMCID: PMC8557084 DOI: 10.1155/2021/9970859] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 08/10/2021] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVE To assess factors associated with adherence to clinical practice guidelines (CPGs) for type 2 diabetes mellitus (T2DM). METHODS A cross-sectional multicenter study based on a two-round Delphi survey was designed. A total of 98 endocrinologists (mean age 45 years) involved in the care of T2DM patients completed a 43-item questionnaire assessing different aspects of adherence related to CPGs. RESULTS Most participants worked in tertiary care public hospitals. All participants used CPGs, with ADA/EASD as the most common (99%). The lack of time, establishment of an individualized management of patients, insufficient human resources, and therapeutic inertia were scored as the main reasons for not following CPGs recommendations. Participants agreed that insufficient material resources and limitations established by the healthcare system prevent adherence to CPGs. The risk of hypoglycemia was considered to be limiting factor for the patients' integral control. Also, there was consensus on the need to have the support of nursing personnel with specific training in diabetes as well as dietitians and podiatrists. There was disagreement regarding the influence on adherence to CPGs of patient's characteristics not matching those of CPGs, patient's preferences, tolerability of the action recommended, concomitant comorbidities, or pluripathological conditions. Differences according to the participant's age (≤40 years vs. >40 years) were not found. Therapeutic inertia and lack of time did not show a significant correlation. CONCLUSIONS Nonadherence to CPGs on T2DM is a multifactorial problem but the existence multiple CPGs, the lack of time, the therapeutic inertia, and insufficient human resources have been identified as factors limiting adherence. Hypoglycemia continues to be a barrier for achievement of targets recommended by CPGs.
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Affiliation(s)
| | - Gloria Cánovas
- Service of Endocrinology, Hospital de Fuenlabrada, Madrid, Spain
| | - Alejandra Durán
- Service of Endocrinology, Hospital Clínico San Carlos, Madrid, Spain
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