Prevalence of Under-Prescription in Elderly Type 2 Diabetic Patients in the Primary Care Unit of a University Hospital

Objectives: This study aimed to assess the prevalence of under-prescription among elderly type 2 diabetic patients in the primary care unit of a university hospital in southern Thailand and identify the associated factors.Material and Methods: A 1-year retrospective medical record review was conducted in elderly type 2 diabetic patients treated continuously in the primary care unit. Under-prescription was the primary outcome assessed from criteria developed from the START criteria (2015), Thailand’s clinical practice guideline for diabetes (2014), and for hypertension (2015).Results: This study included 458 medical records that fit our inclusion criteria. The median age was 69.1 years old and more than 80% of them had a comorbidity of dyslipidemia or hypertension. The prevalence of under-prescription in elderly type 2 diabetic patients was 84.5%. The most commonly omitted medication was aspirin for primary prevention of cardiovascular disease. An increased number of medications received and having cardiovascular disease was associated with a lower risk of under-prescription.Conclusion: The prevalence of the omission of beneficial medications in elderly type 2 diabetic patients in the primary care unit of a university hospital was high, especially under-prescription of aspirin for primary prevention of cardiovascular disease.

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Appropriateness of aspirin prescribing for primary and secondary prevention of cardiovascular disease in type 2 diabetes in different care settings

Irish Journal of Medical Science (1971 -) ◽

10.1007/s11845-021-02649-5 ◽

2021 ◽

Author(s):

Shi Ying Tan ◽

Heather Cronin ◽

Stephen Byrne ◽

Adrian O’Donovan ◽

Antoinette Tuthill

Keyword(s):

Type 2 Diabetes ◽

Cardiovascular Disease ◽

Primary Care ◽

Primary Prevention ◽

Secondary Prevention ◽

Shared Care ◽

University Hospital ◽

Cross Sectional ◽

Prevention Of Cardiovascular Disease

Abstract Background Type 2 diabetes is associated with an increased cardiovascular risk. Use of aspirin has been shown to be of benefit for secondary prevention of cardiovascular disease in patients with type 2 diabetes; benefits in primary prevention have not been clearly proven. Aims This study aims to (a) determine if aspirin is prescribed appropriately in type 2 diabetes for primary or secondary prevention of cardiovascular disease (CVD) and (b) evaluate whether there are differences in aspirin prescribing according to where people receive their care. Design Cross-sectional study Methods The medical records of individuals with type 2 diabetes aged over 18 years and attending Elmwood Primary Care Centre and Cork University Hospital Diabetes outpatient clinics (n = 400) between February and August 2017 were reviewed. Results There were 90 individuals exclusively attending primary care and 310 persons attending shared care. Overall, 49.0% (n = 196) of those were prescribed aspirin, of whom 42.3% were using it for secondary prevention. Aspirin was used significantly more in people attending shared care (p < 0.001). About 10.8% of individuals with diabetes and CVD attending shared care met guidelines for, but were not prescribed aspirin. Conclusion A significant number of people with type 2 diabetes who should have been prescribed aspirin for secondary prevention were not receiving it at the time of study assessment. In contrast, a substantial proportion who did not meet criteria for aspirin use was prescribed it for primary prevention.

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