Evaluation of Clinical Practices and Patient Behaviours
in Type 2 Diabetes

Dr. Mitchell Levine, Dr. Lisa Dolovich, Dr. Anne Holbrook, Dr. Kevin Brazil

Background

More than 1 in 20 Canadian adults have diabetes, and adults with diabetes are more than twice as likely to die prematurely compared to non-diabetic adults. Studies have demonstrated that optimizing blood glucose control through diet and medications can reduce diabetes complication rates. As well, patient education and special surveillance by health care providers to identify complications early can reduce morbidity associated with this chronic disease. Unfortunately these practices are not applied as often as they should be, although the magnitude of this problem is uncertain at present.

Study Objectives

Using funding received from Green Shield Canada, this project will investigate the extent and reasons that best practices (treatment, surveillance, education) in diabetes care do not always occur.

Methods

The proposed project will enroll 800 patients with type 2 diabetes. Patients will be recruited through pharmacies instead of medical clinics to avoid cluster effects that would occur if patients were enrolled from a limited number of medical practices. Using an established network of community pharmacies from across Canada (in Nova Scotia, Quebec, Ontario and B.C.) adult patients filling a prescription for an oral hypoglycemic medication will be asked to participate in the study.

Using a standardized questionnaire, patients will be interviewed over the telephone. In addition to traditional issues of glucose monitoring, hypoglycemic medication use and diet, the survey will probe the use of patient education programs and special surveillance activities by health care providers designed to identify diabetes complications early on.

The analysis will use descriptive statistics to identify gaps in the adoption of best practices and the barriers that prevent the delivery of best practices and inferential statistics to compare results across ages and provinces.

Future Implications

Findings from this study will improve understanding of what is occurring in the community setting, and why some suboptimal actions are occurring (from a patient perspective). Findings will also enable opportunities to develop interventions to improve the management of diabetes from a comprehensive perspective, involving patients, physicians, pharmacists and other health care providers.

For further information about this study, please contact Dr. Mitchell Levine.