National Healthcare Quality and Disparities Report
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- Ambulatory Care and Surgery (1)
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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 12 of 12 Research Studies DisplayedEverhart A, Desai NR, Dowd B
Physician variation in the de-adoption of ineffective statin and fibrate therapy.
The objective of this study was to describe physicians' variation in de-adopting concurrent statin and fibrate therapy for type 2 diabetic patients following a reversal in clinical evidence. Researchers modeled fibrate use among Medicare Advantage and commercially insured type 2 diabetic statin users before and after the publication of the ACCORD lipid trial. Findings showed that, on average, physicians decreased fibrate prescribing following the trial; however, many physicians increased prescribing following the trial. Observable physician characteristics did not explain variations in prescribing.
AHRQ-funded; HS025164; HS000036.
Citation: Everhart A, Desai NR, Dowd B .
Physician variation in the de-adoption of ineffective statin and fibrate therapy.
Health Serv Res 2021 Oct;56(5):919-31. doi: 10.1111/1475-6773.13630..
Keywords: Diabetes, Medication, Practice Patterns, Chronic Conditions
Le P, Chaitoff A, Misra-Hebert AD
Use of antihyperglycemic medications in U.S. adults: an analysis of the National Health and Nutrition Examination Survey.
The objectives of this study were to examine trends in the use of diabetes medications and to determine whether physicians individualize diabetes treatment as recommended by the American Diabetes Association (ADA). Using data from the National Health and Nutrition Examination Survey, findings suggested that the use of metformin and insulin analogs increased, while the use of sulfonylureas, TZDs, and human insulin decreased. Insurance, but not income, was associated with the use of higher-cost medications. Following ADA recommendations, the use of metformin increased, but physicians generally did not individualize treatment according to patients' characteristics.
AHRQ-funded; HS024128.
Citation: Le P, Chaitoff A, Misra-Hebert AD .
Use of antihyperglycemic medications in U.S. adults: an analysis of the National Health and Nutrition Examination Survey.
Diabetes Care 2020 Jun;43(6):1227-33. doi: 10.2337/dc19-2424..
Keywords: Medication, Diabetes, Practice Patterns, Chronic Conditions
McCoy RG, Dykhoff HJ, Sangaralingham L
Adoption of new glucose-lowering medications in the U.S.-the case of SGLT2 inhibitors: nationwide cohort study.
This study examined use of new glucose-lowering medications called sodium-glucose cotransporter-2 inhibitors (SGLT2i) that was the most recently approved class of medications for diabetes type 1 and 2 patients. This class of medications have shown additional cardio- and renal-protective benefits as well as lower risk of hypoglycemia. A retrospective analysis of medical and pharmacy claims data from OptumLabs Data Warehouse was conducted for commercially insured and Medicare Advantage adult beneficiaries who filled any glucose-lowering medication from 2013-2016. Among a cohort of over 1 million, only 7.2% initiated a SGLT2i prescription. Patients with other complications, age 75 or older, black, and those with Medicare Advantage were less likely to start a SGLT2i.
AHRQ-funded; HS024075; HS025164; HS025402; HS025517; HS022882.
Citation: McCoy RG, Dykhoff HJ, Sangaralingham L .
Adoption of new glucose-lowering medications in the U.S.-the case of SGLT2 inhibitors: nationwide cohort study.
Diabetes Technol Ther 2019 Dec;21(12):702-12. doi: 10.1089/dia.2019.0213.
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Keywords: Medication, Diabetes, Practice Patterns
Khan NNS, Kelly-Blake K, Luo Z
Sex differences in statin prescribing in diabetic and heart disease patients in FQHCs: a comparison of the ATPIII and 2013 ACC/AHA cholesterol guidelines.
The study’s purpose was to determine differences in the rate of statin prescribing by sex based on the Adult Treatment Panel (ATP) III and 2013 American College of Cardiology (ACC/American Heart Association) cholesterol guidelines in Federally Qualified Health Centers (FQHCs). The study also wanted to determine adherence to those guidelines based on the 2013 recommendations. Two FQHCs were used and patients with coronary heart disease and diabetes mellitus (DM) were recruited. There was no difference between men and women in statin prescribing under ATPIII; however there was underprescribing for both men and women with atherosclerotic cardiovascular disease (ASCVD).
AHRQ-funded; HS018104.
Citation: Khan NNS, Kelly-Blake K, Luo Z .
Sex differences in statin prescribing in diabetic and heart disease patients in FQHCs: a comparison of the ATPIII and 2013 ACC/AHA cholesterol guidelines.
Health Serv Res Manag Epidemiol 2019 Mar 5;6:2333392818825414. doi: 10.1177/2333392818825414..
Keywords: Cardiovascular Conditions, Diabetes, Medication, Practice Patterns, Sex Factors
McCreedy EM, Kane RL, Gollust SE
Patient-centered guidelines for geriatric diabetes care: potential missed opportunities to avoid harm.
Clinicians strive to deliver individualized, patient-centered care. However, these intentions are understudied. This research explored how patient characteristics associated with a high risk-to-benefit ratio with hypoglycemia medications affected decision making by primary care clinicians. The investigators found that primary care clinicians often chose to intensify glycemic control despite individual patient factors that warranted higher glycemic targets based on existing guidelines.
AHRQ-funded; HS000011.
Citation: McCreedy EM, Kane RL, Gollust SE .
Patient-centered guidelines for geriatric diabetes care: potential missed opportunities to avoid harm.
J Am Board Fam Med 2018 Mar-Apr;31(2):192-200. doi: 10.3122/jabfm.2018.02.170141..
Keywords: Diabetes, Elderly, Patient-Centered Healthcare, Guidelines, Evidence-Based Practice, Decision Making, Medication, Primary Care, Practice Patterns, Provider: Physician, Provider: Clinician, Provider
Flory J, Gerhard T, Stempniewicz N
Comparative adherence to diabetes drugs: an analysis of electronic health records and claims data.
The objective of this brief report is to compare adherence rates for 6 major classes of diabetes medications: metformin, sulfonylurea, thiazolidinedione, basal insulin, DPP-4 inhibitors, and GLP-1 receptor agonists. The authors note that the rates at which diabetes drugs are prescribed, and the rates at which patients actually take them, differ substantially. The authors also note that the physicians should be aware of potentially significant challenges concerning adherence to newer agents.
AHRQ-funded; HS023898.
Citation: Flory J, Gerhard T, Stempniewicz N .
Comparative adherence to diabetes drugs: an analysis of electronic health records and claims data.
Diabetes Obes Metab 2017 Aug;19(8):1184-87. doi: 10.1111/dom.12931..
Keywords: Diabetes, Electronic Health Records (EHRs), Patient Adherence/Compliance, Practice Patterns, Medication
Morrato EH, Brewer SE, Campagna EJ
Glucose testing for adults receiving Medicaid and antipsychotics: a population-based prescriber survey on behaviors, attitudes, and barriers.
The authors aimed to assess provider attitudes about glucose testing for adults prescribed second-generation antipsychotic medication. They concluded that establishing organizational priority across all treatment settings is important for achieving population-based diabetes screening goals for all Medicaid patients receiving antipsychotics.
AHRQ-funded; HS019464.
Citation: Morrato EH, Brewer SE, Campagna EJ .
Glucose testing for adults receiving Medicaid and antipsychotics: a population-based prescriber survey on behaviors, attitudes, and barriers.
Psychiatr Serv 2016 Jul 1;67(7):798-802. doi: 10.1176/appi.ps.201500181.
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Keywords: Diabetes, Medication, Behavioral Health, Practice Patterns, Screening
Chung S, Zhao B, Lauderdale D
Initiation of treatment for incident diabetes: evidence from the electronic health records in an ambulatory care setting.
The researchers examined patterns and predictors of initiation of treatment for incident diabetes in an ambulatory care setting in the US. They found that only half of patients were treated during the first year following diabetes incidence, and only 20% of patients received both medication prescription and lifestyle modification interventions.
AHRQ-funded; HS019815.
Citation: Chung S, Zhao B, Lauderdale D .
Initiation of treatment for incident diabetes: evidence from the electronic health records in an ambulatory care setting.
Prim Care Diabetes 2015 Feb;9(1):23-30. doi: 10.1016/j.pcd.2014.04.005..
Keywords: Ambulatory Care and Surgery, Care Management, Diabetes, Electronic Health Records (EHRs), Health Information Technology (HIT), Primary Care, Practice Patterns
Kuo YF, Goodwin JS, Chen NW
Diabetes mellitus care provided by nurse practitioners vs primary care physicians.
The study objective was to compare processes and cost of care of older adults with diabetes mellitus cared for by nurse practitioners (NPs) with processes and cost of those cared for by primary care physicians (PCPs). It concluded that nurse practitioners were similar to PCPs or slightly lower in their rates of diabetes mellitus guideline–concordant care.
AHRQ-funded; HS020642; HS022134.
Citation: Kuo YF, Goodwin JS, Chen NW .
Diabetes mellitus care provided by nurse practitioners vs primary care physicians.
J Am Geriatr Soc 2015 Oct;63(10):1980-8. doi: 10.1111/jgs.13662..
Keywords: Chronic Conditions, Diabetes, Elderly, Primary Care, Practice Patterns
Sorkin DH, Billimek J, August KJ
AHRQ Author: Ngo-Metzger Q
Mental health symptoms and patient-reported diabetes symptom burden: implications for medication regimen changes.
The aim of this paper was to examine the relative contribution of glycaemic control (HbA1C) and depressive symptoms on diabetes-related symptom burden (hypoglycaemia and hyperglycaemia) in order to guide medication modification. The authors found that mental health symptoms are associated with higher levels of patient-reported diabetes-related symptoms, but the association between diabetes-related symptoms and subsequent regimen modifications is diminished in patients with greater depressive symptoms.
AHRQ-authored.
Citation: Sorkin DH, Billimek J, August KJ .
Mental health symptoms and patient-reported diabetes symptom burden: implications for medication regimen changes.
Fam Pract 2015 Jun;32(3):317-22. doi: 10.1093/fampra/cmv014.
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Keywords: Depression, Diabetes, Medication, Practice Patterns, Social Determinants of Health
Magnan EM, Gittelson R, Bartels CM
Establishing chronic condition concordance and discordance with diabetes: a Delphi study.
This study aimed to provide more information for the future research and clinical use of the concordant/discordant framework by increasing the number of conditions that can be characterized as concordant or discordant with diabetes. By finding that 12 conditions were concordant with diabetes care and 50 were discordant, the study significantly adds to the number of conditions for which there is information on concordance and discordance for diabetes care.
AHRQ-funded; HS018368; HS007646; HS021899.
Citation: Magnan EM, Gittelson R, Bartels CM .
Establishing chronic condition concordance and discordance with diabetes: a Delphi study.
BMC Fam Pract 2015 Mar 28;16:42. doi: 10.1186/s12875-015-0253-6..
Keywords: Chronic Conditions, Diabetes, Primary Care, Practice Patterns
Camelo Castillo W, Boggess K, Stürmer T
Trends in glyburide compared with insulin use for gestational diabetes treatment in the United States, 2000-2011.
The researchers sought to characterize pharmacologic treatment of women with gestational diabetes (GDM) by describing trends in the use of glyburide compared with insulin over the past decade (2000-2011) and identifying predictors of initial choice of pharmacotherapy. They found that glyburide has replaced insulin as the more common pharmacotherapy for GDM among those privately insured.
AHRQ-funded; HS017950
Citation: Camelo Castillo W, Boggess K, Stürmer T .
Trends in glyburide compared with insulin use for gestational diabetes treatment in the United States, 2000-2011.
Obstet Gynecol. 2014 Jun;123(6):1177-84. doi: 10.1097/AOG.0000000000000285..
Keywords: Diabetes, Maternal Care, Medication, Practice Patterns, Pregnancy, Women