Factors associated with intensification of oral Diabetes medications in primary care provider-patient dyads: A cohort study

Shari Danielle Bolen, Eric Bricker, T. Alafia Samuels, Hsin Chieh Yeh, Spyridon Marinopoulos, Maura Mcguire, Marcela Abuid, Frederick L. Brancati

Research output: Contribution to journalArticle

Abstract

Objective-Although suboptimal glycemic control is known to be common in diabetic adults, few studies have evaluated factors at the level of the physician-patient encounter. Our objective was to identify novel visit-based factors associated with intensification of oral diabetes medications in diabetic adults. Research design and methods-We conducted a nonconcurrent prospective cohort study of 121 patients with type 2 diabetes and hyperglycemia (A1C ≥8%) enrolled in an academically affiliated managed-care program. Over a 24-month interval (1999-2001), we identified 574 hyperglycemic visits. We measured treatment intensification and factors associated with intensification at each visit. Results-Provider-patient dyads intensified oral diabetes treatment in only 128 (22%) of 574 hyperglycemic visits. As expected, worse glycemia was an important predictor of intensification. Treatment was more likely to be intensified for patients with visits that were "routine" (odds ratio [OR] 2.55 [95% CI 1.49-4.38]), for patients taking two or more oral diabetes drugs (2.82 [1.74-4.56]), or for patients with longer intervals between visits (OR per 30 days 1.05 [1.00-1.10]). In contrast, patients with less recent A1C measurements (OR >30 days before the visit 0.53 [0.34-0.85]), patients with a higher number of prior visits (OR per prior visit 0.94 [0.88-1.00]), and African American patients (0.59 [0.35-1.00]) were less likely to have treatment intensified. Conclusions-Failure to intensify oral diabetes treatment is common in diabetes care. Quality improvement measures in type 2 diabetes should focus on overcoming inertia, improving continuity of care, and reducing racial disparities.

Original languageEnglish (US)
Pages (from-to)25-31
Number of pages7
JournalDiabetes Care
Volume32
Issue number1
DOIs
StatePublished - Jan 2009

Fingerprint

Primary Health Care
Cohort Studies
Odds Ratio
Type 2 Diabetes Mellitus
Therapeutics
Continuity of Patient Care
Managed Care Programs
Quality Improvement
Hyperglycemia
African Americans
Research Design
Prospective Studies
Physicians
Pharmaceutical Preparations

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Advanced and Specialized Nursing

Cite this

Factors associated with intensification of oral Diabetes medications in primary care provider-patient dyads : A cohort study. / Bolen, Shari Danielle; Bricker, Eric; Samuels, T. Alafia; Yeh, Hsin Chieh; Marinopoulos, Spyridon; Mcguire, Maura; Abuid, Marcela; Brancati, Frederick L.

In: Diabetes Care, Vol. 32, No. 1, 01.2009, p. 25-31.

Research output: Contribution to journalArticle

Bolen, Shari Danielle ; Bricker, Eric ; Samuels, T. Alafia ; Yeh, Hsin Chieh ; Marinopoulos, Spyridon ; Mcguire, Maura ; Abuid, Marcela ; Brancati, Frederick L. / Factors associated with intensification of oral Diabetes medications in primary care provider-patient dyads : A cohort study. In: Diabetes Care. 2009 ; Vol. 32, No. 1. pp. 25-31.
@article{88d912e106e04074b15f3374ce6340b4,
title = "Factors associated with intensification of oral Diabetes medications in primary care provider-patient dyads: A cohort study",
abstract = "Objective-Although suboptimal glycemic control is known to be common in diabetic adults, few studies have evaluated factors at the level of the physician-patient encounter. Our objective was to identify novel visit-based factors associated with intensification of oral diabetes medications in diabetic adults. Research design and methods-We conducted a nonconcurrent prospective cohort study of 121 patients with type 2 diabetes and hyperglycemia (A1C ≥8{\%}) enrolled in an academically affiliated managed-care program. Over a 24-month interval (1999-2001), we identified 574 hyperglycemic visits. We measured treatment intensification and factors associated with intensification at each visit. Results-Provider-patient dyads intensified oral diabetes treatment in only 128 (22{\%}) of 574 hyperglycemic visits. As expected, worse glycemia was an important predictor of intensification. Treatment was more likely to be intensified for patients with visits that were {"}routine{"} (odds ratio [OR] 2.55 [95{\%} CI 1.49-4.38]), for patients taking two or more oral diabetes drugs (2.82 [1.74-4.56]), or for patients with longer intervals between visits (OR per 30 days 1.05 [1.00-1.10]). In contrast, patients with less recent A1C measurements (OR >30 days before the visit 0.53 [0.34-0.85]), patients with a higher number of prior visits (OR per prior visit 0.94 [0.88-1.00]), and African American patients (0.59 [0.35-1.00]) were less likely to have treatment intensified. Conclusions-Failure to intensify oral diabetes treatment is common in diabetes care. Quality improvement measures in type 2 diabetes should focus on overcoming inertia, improving continuity of care, and reducing racial disparities.",
author = "Bolen, {Shari Danielle} and Eric Bricker and Samuels, {T. Alafia} and Yeh, {Hsin Chieh} and Spyridon Marinopoulos and Maura Mcguire and Marcela Abuid and Brancati, {Frederick L.}",
year = "2009",
month = "1",
doi = "10.2337/dc08-1297",
language = "English (US)",
volume = "32",
pages = "25--31",
journal = "Diabetes Care",
issn = "1935-5548",
publisher = "American Diabetes Association Inc.",
number = "1",

}

TY - JOUR

T1 - Factors associated with intensification of oral Diabetes medications in primary care provider-patient dyads

T2 - A cohort study

AU - Bolen, Shari Danielle

AU - Bricker, Eric

AU - Samuels, T. Alafia

AU - Yeh, Hsin Chieh

AU - Marinopoulos, Spyridon

AU - Mcguire, Maura

AU - Abuid, Marcela

AU - Brancati, Frederick L.

PY - 2009/1

Y1 - 2009/1

N2 - Objective-Although suboptimal glycemic control is known to be common in diabetic adults, few studies have evaluated factors at the level of the physician-patient encounter. Our objective was to identify novel visit-based factors associated with intensification of oral diabetes medications in diabetic adults. Research design and methods-We conducted a nonconcurrent prospective cohort study of 121 patients with type 2 diabetes and hyperglycemia (A1C ≥8%) enrolled in an academically affiliated managed-care program. Over a 24-month interval (1999-2001), we identified 574 hyperglycemic visits. We measured treatment intensification and factors associated with intensification at each visit. Results-Provider-patient dyads intensified oral diabetes treatment in only 128 (22%) of 574 hyperglycemic visits. As expected, worse glycemia was an important predictor of intensification. Treatment was more likely to be intensified for patients with visits that were "routine" (odds ratio [OR] 2.55 [95% CI 1.49-4.38]), for patients taking two or more oral diabetes drugs (2.82 [1.74-4.56]), or for patients with longer intervals between visits (OR per 30 days 1.05 [1.00-1.10]). In contrast, patients with less recent A1C measurements (OR >30 days before the visit 0.53 [0.34-0.85]), patients with a higher number of prior visits (OR per prior visit 0.94 [0.88-1.00]), and African American patients (0.59 [0.35-1.00]) were less likely to have treatment intensified. Conclusions-Failure to intensify oral diabetes treatment is common in diabetes care. Quality improvement measures in type 2 diabetes should focus on overcoming inertia, improving continuity of care, and reducing racial disparities.

AB - Objective-Although suboptimal glycemic control is known to be common in diabetic adults, few studies have evaluated factors at the level of the physician-patient encounter. Our objective was to identify novel visit-based factors associated with intensification of oral diabetes medications in diabetic adults. Research design and methods-We conducted a nonconcurrent prospective cohort study of 121 patients with type 2 diabetes and hyperglycemia (A1C ≥8%) enrolled in an academically affiliated managed-care program. Over a 24-month interval (1999-2001), we identified 574 hyperglycemic visits. We measured treatment intensification and factors associated with intensification at each visit. Results-Provider-patient dyads intensified oral diabetes treatment in only 128 (22%) of 574 hyperglycemic visits. As expected, worse glycemia was an important predictor of intensification. Treatment was more likely to be intensified for patients with visits that were "routine" (odds ratio [OR] 2.55 [95% CI 1.49-4.38]), for patients taking two or more oral diabetes drugs (2.82 [1.74-4.56]), or for patients with longer intervals between visits (OR per 30 days 1.05 [1.00-1.10]). In contrast, patients with less recent A1C measurements (OR >30 days before the visit 0.53 [0.34-0.85]), patients with a higher number of prior visits (OR per prior visit 0.94 [0.88-1.00]), and African American patients (0.59 [0.35-1.00]) were less likely to have treatment intensified. Conclusions-Failure to intensify oral diabetes treatment is common in diabetes care. Quality improvement measures in type 2 diabetes should focus on overcoming inertia, improving continuity of care, and reducing racial disparities.

UR - http://www.scopus.com/inward/record.url?scp=64649106070&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=64649106070&partnerID=8YFLogxK

U2 - 10.2337/dc08-1297

DO - 10.2337/dc08-1297

M3 - Article

C2 - 18931096

AN - SCOPUS:64649106070

VL - 32

SP - 25

EP - 31

JO - Diabetes Care

JF - Diabetes Care

SN - 1935-5548

IS - 1

ER -