Assessing cardiometabolic treatment quality in general practice

This dissertation focuses on quality assessment of cardiometabolic treatment in patients with type 2 diabetes in general practice.
First, methods are developed for collecting data related to diabetes care from electronic medical records. Important elements include a uniform procedure for patient selection and the extraction of relevant data from records without burdening practices with extra registration requirements. These methods were successfully implemented in the Groningen Initiative to Analyse Type 2 diabetes Treatment (GIANTT) project to build a longitudinal observational database for monitoring diabetes care.
The second part concerns quality indicators for diabetes management. A comparison is made between commonly used cross-sectional indicators and newly developed “sequential” indicators which shows the value of these new indicators. A systematic review on prescribing indicators is presented, describing different types of existing indicators and their validity. Furthermore, an overview of the quality of cardiometabolic risk factor management is given, showing contrasting results for the various indicators.
The third part focuses on factors mentioned as reasons not to modify cardiometabolic treatment when indicated. Some of these, e.g. using higher thresholds than recommended, waiting for the next risk factor measurement, competing demands, and medication non-adherence were found to be related to treatment decisions for hypertension and hyperglycaemia. Polypharmacy, however, was not a factor of influence.
This dissertation provides new methods of obtaining information from medical records for quality assessment and scientific research. Furthermore, the usefulness of sequential indicators for quality assessment is shown. Finally, the studies on determinants of treatment modifications show targets for interventions.

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