Joan Burns

Quality of diabetes care and coronary heart disease absolute risk in patients with type 2 diabetes mellitus in Australian general practice

Objective: To examine the quality of diabetes care and prevention of cardiovascular disease (CVD) in Australian general practice patients with type 2 diabetes and to investigate its relationship with coronary heart disease absolute risk (CHDAR). Methods: A total of 3286 patient records were extracted from registers of patients with type 2 diabetes held by 16 divisions of general practice (250 practices) across Australia for the year 2002. CHDAR was estimated using the United Kingdom Prospective Diabetes Study algorithm with higher CHDAR set at a 10 year risk of >15%. Multivariate multilevel logistic regression investigated the association between CHDAR and diabetes care. Results: 47.9% of diabetic patient records had glycosylated haemoglobin (HbA1c) >7%, 87.6% had total cholesterol ⩾4.0 mmol/l, and 73.8% had blood pressure (BP) ⩾130/85 mm Hg. 57.6% of patients were at a higher CHDAR, 76.8% of whom were not on lipid modifying medication and 66.2% were not on antihypertensive medication. After adjusting for clustering at the general practice level and age, lipid modifying medication was negatively related to CHDAR (odds ratio (OR) 0.84) and total cholesterol. Antihypertensive medication was positively related to systolic BP but negatively related to CHDAR (OR 0.88). Referral to ophthalmologists/optometrists and attendance at other health professionals were not related to CHDAR. Conclusions: At the time of the study the diabetes and CVD preventive care in Australian general practice was suboptimal, even after a number of national initiatives. The Australian Pharmaceutical Benefits Scheme (PBS) guidelines need to be modified to improve CVD preventive care in patients with type 2 diabetes.

Cardiovascular risk management and its impact in Australian general practice patients with type 2 diabetes in urban and rural areas

Objective:  To investigate the cardiovascular disease (CVD) risk management and its impact on Australian general practice patients with type 2 diabetes in urban and rural areas between 2000 and 2002, and to compare trends over time and differences between urban and rural areas.

Evolution of a register recall system to enable the delivery of better quality of care in general practice

Australian Divisions of General Practice have a key role to play in supporting general practitioners (GPs) to provide proactive, preventive care for their patients with cardiovascular disease (CVD) and diabetes. They can achieve this by providing them with quality improvement information generated by population health monitoring tools such as CARDIAB®™. CARDIAB®™ has prompted the development of standard minimum clinical datasets, enabled recording, monitoring and audit of quality of care and health outcomes for diabetes and cardiovascular patients who are locally enrolled in Division programs. It has also supported the improvement of services within general practice and local secondary care services. GPs have been able to audit their clinical performance and monitor quality of care and health outcomes in diabetes and cardiovascular disease. This article describes the evolution of the CARDIAB®™ database from the grass roots level to a nationally accepted database.

Utilization of the CARDIAB®™ database system to promote quality of care in Australian general practice:

This article describes quality of care and health outcome indicator data aggregated from seven Australian Divisions of General Practice, using the CARDIAB®™ register recall system, involving 4359 people with diabetes. Eighty-eight per cent of patients registered had type 2 diabetes. The process of care of these patients was evaluated in nine parameters critical to quality of care in diabetes: glycaemic control (HbA1c), blood pressure, body mass index, total cholesterol levels, triglyceride levels, high density lipoprotein levels (HDL), microalbumin level, foot checks and eye checks. The data provide important baseline information for program planning, service delivery, quality assurance and quality improvement at local, state and national levels. They demonstrate the potential of CARDIAB®™ to provide support to general practice in the management of diabetes. The reach of such registers will be facilitated by increased computerization of general practice records. A policy framework which addresses key concerns was central to recruitment to the project.

Register-recall systems: tools for chronic disease management in general practice

The Divisions Diabetes and Cardiovascular Disease Quality Improvement Project (DDCQIP) is a national project that aims to promote quality improvement initiatives among Divisions of General Practice. DDCQIP has investigated the growth of Division-based diabetes and cardiovascular disease register–recall systems and the role they play in promoting evidence-based structured care within general practice. In the period 2000–2002, an increase in the number of GPs using register–recall systems and the rise in the number of active registered patients have made it possible to monitor quality of care and health outcome indicators, and contributed to the growth of a Division-based population health program.