Quality of prescribing: a study of guideline adherence of medication in patients with diabetes mellitus

This study aimed to evaluate the quality of prescribing of cardiovascular medication by a criterion‐based approach with reference to national treatment guidelines for the care of patients with diabetes mellitus. Case notes and database records of diabetic outpatients (age range 15–75 years) managed in a secondary care clinic of a major teaching hospital were reviewed and 23 criteria in a previously evaluated tool were applied to determine adherence to guidelines.

For the 214 study patients (57.5% male, 69.6% type 2 diabetes mellitus), mean (SD) age was 52.2 (16.3) years and mean (SD) BMI was 30.3 (6.6) kg/m². Overall guideline adherence was 74.0% (95% CI: 71.2, 76.8). Excluding criteria that were only applicable to less than 10% of the total study group, the three criteria with the highest adherence were ‘use of metformin in overweight patients’: 95.1% (91.0, 99.3), ‘use of statin in primary prevention of CHD’: 94.3% (88.8, 99.7) and ‘use of aspirin in secondary prevention of CHD’: 93.8% (85.4, 100). Similarly, the three criteria with the lowest adherence were ‘achievement of target blood pressure in patients on antihypertensives’: 43.4% (34.2, 52.5), ‘use of aspirin in primary prevention of CHD’: 51.2% (35.9, 66.5) and ‘use of ACE inhibitor in patients with defined risk factors’: 54.8% (44.7, 65.0). Among the overall level of non‐adherence (26.0% of total applicable criteria) the proportion of criteria in which non‐adherence was ‘justified’ by the prescriber was 9.2% (7.4, 11.0), and the ‘unjustified’ proportion was 16.8% (14.4, 19.2).

In conclusion, overall adherence to criteria was relatively high. Targets for improving prescribing practice in this diabetic population were identified from apparent low‐adherence criteria and from the overall need to improve documentation of prescribing decisions. Copyright © 2005 John Wiley & Sons, Ltd.