Effectiveness of an HbA1c tracking tool on primary care management of diabetes mellitus: glycaemic control, clinical practice and usability.

OBJECTIVE: To determine if a laboratory data report (the HbA1c Tracking Tool) could be used as an effective intervention to improve diabetes management. DESIGN: A longitudinal quasi-experimental cohort design was used to test the effectiveness of an HbA1c summary report sent to primary care physicians for all patients having HbA1c levels greater than 7%. SETTING: Moncton, New Brunswick, Canada. SAMPLE SELECTION: Administrative data from all adult patients with diabetes who had had at least two HbA1c measurements within the year prior to the initiation of the HbA1c Tracking Tool, and who had had five years of HbA1c measurements (2002-2007) overall was included. INTERVENTIONS: In March 2006 all primary care physicians began receiving HbA1c summary reports (through the HbA1c Tracking Tool) as a means to improving the management of diabetes. MAIN OUTCOME MEASURES: (a) patient glycaemic control as indicated by HbA1c levels, (b) physician adherence to practice guidelines as indicated by measuring the mean number of HbA1c tests ordered per patient per year, and (c) physician usage rates of the HbA1c Tracking Tool in clinical practice. RESULTS: The sample (n=955) was divided into three subgroups based on flagged HbA1c level (7-<8%, 8-9%, >9%). The strongest effect of the intervention was found in the two groups with the poorest glycaemic control. The effect was stronger in the >9% group (from 10.1 to 9.3%), than in the 8-9% group (a drop of 8.5 to 8.3%). Longitudinal analyses over a five-year period indicated the same findings. Patients were also found to receive more tests across time (from 2.45 tests per year to 3.0 across five years). In terms of usage, 92.1% of the physicians surveyed used the tool in their practice. CONCLUSION: Routinely collected hospital laboratory data can be used both as the basis for an information-based intervention and as a tool to monitor quality of diabetes care.

Effect of utilization policies for fluoroquinolones: a pilot study in nova scotia hospitals.

BACKGROUND: Antimicrobial resistance results in increased morbidity, mortality, and costs to the health care system. Evidence suggests an association between the use of antimicrobials in hospitals and the development of antimicrobial resistance. Fluoroquinolones constitute one group of antimicrobials that are effective against a variety of bacterial infections, yet they may be subject to misuse. Many hospitals in Nova Scotia have implemented policies to improve antimicrobial prescribing, but the impact of these policies on utilization is unknown. OBJECTIVES: To evaluate the use of fluoroquinolones in Nova Scotia hospitals using the World Health Organization's Anatomical Therapeutic Chemical classification system with defined daily doses (ATC/DDD) and to examine the influence of hospital policies for utilization of fluoroquinolones in community-acquired pneumonia. METHODS: During the study period (April 1, 1997, to March 31, 2003), fluoroquinolones were administered at 31 of the 37 hospitals in Nova Scotia's 9 district health authorities. Hospital administrative data, hospital characteristics, and pharmaceutical purchasing data related to use of these drugs were aggregated using the ATC/DDD methodology for the fiscal years 1997/1998 to 2002/2003. District pharmacy directors were surveyed to obtain information about district and individual hospital antibiotic policies. Descriptive statistics were calculated, and univariable regression and multilevel analyses were performed. RESULTS: Mean overall fluoroquinolone use increased over the study period, from 47.2 DDD/1000 bed-days per year in fiscal year 1997/1998 to 163.8 DDD/1000 bed-days per year in fiscal year 2002/2003 (p < 0.001). Multilevel analysis showed that utilization policies aimed at appropriate prescribing did not affect the use of fluoroquinolones. CONCLUSION: This study revealed that drug purchasing, hospital administrative, and diagnostic data could be combined to compare the utilization of fluoroquinolones among different hospitals and district health authorities. Utilization policies had little effect on the amount, type, or route of fluoroquinolone use.