Management of patients with type 2 diabetes and cardiovascular disease in primary care
Notice bibliographique
Résumé
Background and objectiveApproximately 65% of cardiovascular disease (CVD)-related deaths in Australia occur in people with diabetes or pre-diabetes.The aim of this study was to investigate general practice management of risk factors among patients with both conditions. MethodsThis was a cross-sectional study of 33,559 adult patients with both type 2 diabetes and CVD at 1 November 2018, using the general practice data program MedicineInsight. ResultsOne-third of patients did not have a record in their current medications list for all three recommended medicines to reduce cardiovascular risk.Potentially suboptimal monitoring and achievement of targets for diabetes and cardiovascular risk factors was also identified.Most patients using metformin-based combination therapy were prescribed blood glucose-lowering medicines that do not have evidence of cardiovascular benefit. DiscussionThese data suggest opportunities to support general practices to optimise patient management.Datasets such as MedicineInsight can help practices identify patients who may benefit from recall.APPROXIMATELY 65% of all cardiovascular disease (CVD)-related deaths in Australia occur in people with diabetes or pre-diabetes.1 The mortality rate in people with type 2 diabetes (T2D) almost doubles with the coexistence of CVD, resulting in an estimated 12-year reduction in life expectancy.2 Typically, people with T2D experience atherosclerotic CVD earlier and with greater severity than people without T2D.3 Despite their significantly elevated risk, suboptimal prescribing of blood pressure (BP)-lowering, 4,5 lipid-modifying 4-6 and antiplatelet therapy 5 for patients with diabetes and CVD has been reported in Australian primary care.Australian data also show that many patients with diabetes and/or CVD do not meet guideline recommendations for prescribing, 4-10 monitoring and treatment targets for managing cardiovascular risk.5,7 Blood glucose-lowering medicine (GLM) selection is also increasingly complex because of the increase in available medicines, and the focus on cardiovascular safety since the US Food and Drug Administration mandated in 2008 that all new studies must demonstrate cardiovascular safety.11 Several trials have shown not only cardiovascular safety, but also additional cardiovascular and renal benefits over placebo.[12][13][14][15][16][17][18][19][20] The aim of this study was to investigate management of T2D and atherosclerotic CVD risk factors in general practice, using MedicineInsight data to explore medicines prescribed, monitoring performed and achievement of treatment targets.The study was part of a quality improvement program that ran from June 2018 to April 2019 and involved presenting practicelevel data to general practitioners (GPs) at small group meetings to identify opportunities for improvement in clinical care. MethodsA cross-sectional study was conducted using MedicineInsight, a large national general practice database developed and managed by NPS MedicineWise, with funding support from the Australian Government Department of Health.21 MedicineInsight extracts longitudinal, de-identified patient health records including demographics, encounters, diagnoses, prescriptions and pathology tests from Best Practice and Medical Director clinical information systems in participating practices.In October 2018, MedicineInsight had recruited 662 practices across Australia, representing approximately 8.2% of all general practices in Australia and more than 2700 GPs.21 MedicineInsight has national coverage across all states and territories.Practices are recruited to MedicineInsight using non-random sampling.In comparison to national data, Management of patients with type 2 diabetes and cardiovascular disease in primary care
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,002 | 0,009 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,001 | 0,002 |
| Études des sciences et des technologies | 0,001 | 0,000 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,001 | 0,001 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».