Adherence to diabetes clinical practice guidelines to improve prevention and treatment of cardiovascular disease in Quebec: A retrospective cohort 2017-2020 - 18/01/22

Doi : 10.1016/j.deman.2022.100053

Houssein Madar ^a,^{^{1
0000-0002-3517-3943 Houssein Madar},}^⁎ , El-Kebir Ghandour ^b,^{^{2
0000-0002-5410-4265 El-Kebir}}, José Perez ^b, Rémi Rabasa-Lhoret ^c,^{^{3
0000-0003-4706-5170 Rémi Rabasa-Lhoret}}, Lise Gauvin ^d,^{^{4
0000-0002-1562-1307 Lise Gauvin}}, Jean-François Ethier ^a,^{^{5
0000-0001-9408-0109 Jean-François Ethier}}, Marie-Pascale Pomey ^e,^{^{6
0000-0001-5180-8139 Marie-Pascale Pomey}}
^a Interdisciplinary Research Group in Health Informatics, University of Sherbrooke, 500 boulevard Université, Sherbrooke (Québec) J1K 2R1, Canada
^b Institut national d'excellence en santé et en services sociaux (INESSS), 2021 Av. Union, Montréal, Québec H3A 2S9, Canada
^c Montreal Clinical Research Institute, Montréal (Québec), 110 Av. des Pins, Montréal, Québec H2W 1R7, Canada
^d School of Public Health, Department of Social and Preventive Medicine, University of Montreal, 7101 avenue du Parc, 3e étage, Montréal, Québec H3N 1 × 9, Canada
^e School of Public Health, Department of Health Management, Evaluation and Policy, University of Montreal, 7101 avenue du Parc, 3e étage, Montréal, Québec H3N 1 × 9, Canada

^⁎Corresponding author at: Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Québec, Canada, 3001, 12e Avenue N, Sherbrooke, Québec J1H 5N4 Canada.Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Québec, Canada3001, 12e Avenue NSherbrookeQuébecJ1H 5N4Canada

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Highlights

•	Identification and selection of quality indicators in Primary Care Health
•	Retrospective cohort was used with patients with diabetes and/or cardiovascular disease between 2017 and 2020
•	The prescriptions for statins, antiplatelet in secondary prevention and nephroprotective treatment (ACE/ARB) appear in accordance with the Diabetes Canada's 2018- Clinical Practice Guidelines (CPG) and stable from 2017 to 2020
•	The prescriptions of antiplatelet medications in primary prevention is declining and the prescribing of new therapies (SGLT-2 / GLP-1) is increasing between 2017 and 2020, which is consistent with Diabetes Canada's 2018 CPG

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Abstract

Objective: Assess adherence to the Diabetes Clinical Practice Guidelines (CPG) for the Prevention and Treatment of Cardiovascular Disease (CVD) in Family Medicine Groups (FMG) in Quebec.

Methodology: A retrospective cohort was used with patients with diabetes (PWD) and/or CVD, enrolled in a FMG and the Public Prescription Drug Plan (PPDP) between 2017 and 2020.

Results: Six adjusted indicators (gender and age) for the management of CVD in PWD aged 50 and over and enrolled in a FMG and the PPDP were calculated. In 2019-2020, among PWD with CVD, 82.0% were taking a statin, 71.9% were taking an antiplatelet, 66.5% were taking an angiotensin receptor (ARB) blocker or angiotensin-converting enzyme (ACE) inhibitor, and 25.5% were taking cardiac-protection therapies [ sodium/glucose cotransporter 2 (SGLT-2), Glucagon like peptide antagonist (GLP-1)]. Among PWD for 15 years, 50.4% take a statin, while in the absence of CVD, 36.1% take an antiplatelet.

Conclusion: The prescriptions for statin, antiplatelet and ACE/ARB appear in accordance with the CPG and stable from 2017 to 2020. Prescription of antiplatelet in primary prevention was declining between and SGLT-2/GLP-1 were increasing from 2017 to 2020, which is consistent with the recommendations from Diabetes Canada CPG.^{1 Diabetes Canada. Ressources Françaises. : (2018). ressourcesfrancaises;Accessed 19 November 2021.

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Key words : Diabetes, cardiovascular disease, indicators, primary care