%0 Journal Article
%T Improving Compliance with Screening of Diabetic Patients for Microalbuminuria in Primary Care Practice
%A Abeer Anabtawi
%A L. Mary Mathew
%J ISRN Endocrinology
%D 2013
%R 10.1155/2013/893913
%X Studies showed suboptimal compliance rate of primary care physicians with microalbuminuria screening. This study evaluated impact of electronic medical records (EMR) and computerized physicians reminders on compliance rate and showed small to modest improvement. Combining EMR with quality control monitoring has significantly improved compliance [OR 1.556, 95% CI 1.251每1.935, ]. 1. Introduction Diabetic nephropathy develops in 20每40% of diabetic patients and is the leading cause of end-stage renal disease (ESRD) in the western world. The cost for treating diabetic ESRD exceeded $23 billion per year in USA [1, 2]. One of the earliest clinical markers is the appearance of low but abnormal levels (≡30ˋmg/day) of albumin in the urine. Persistent albuminuria in the range of 30每299ˋmg/24ˋh (microalbuminuria) if untreated can progress to macroalbuminuria (≡300ˋmg/24ˋh) with gradual decline in glomerular filtration rate and the development of chronic kidney disease (CKD) [3, 4]. Microalbuminuria is also a marker for increased cardiovascular risk in such patients [5]. Numerous guidelines for diabetic care recommend an annual urine screening test to assess albumin excretion. The American Diabetic Association recommends performing microalbuminuria screening in patients who have had type I diabetes for at least 5 years or in patients with type II diabetes at time of diagnosis [6]. However, studies demonstrated suboptimal compliance of primary care physicians (PCP) with these recommendations with variable compliance rate of 14每49% [7每9]. Several methods were suggested to improve PCP compliance at multiple levels including patient education and reminders, physician education, and continuous charts reviews for quality improvement and feedback [10]. Electronic medical records (EMR) enabled with physician reminder system have gained significant interest in recent years as a tool that is shown to improve compliance [10, 11]. However, the magnitude of this improvement has been variable, and its cost effectiveness remains controversial [12, 13]. This study evaluated the compliance rate of microalbuminuria screening after two years of introducing an EMR enabled with computer-generated reminder system for diabetes care guidelines. It also evaluated the impact of combining EMR with quality control monitoring in enhancing compliance. 2. Methods 2.1. Retrospective Analysis 2.1.1. Patients All patients with type II diabetes, who were registered at Unity Faculty Partners (UFP) primary care facility between January 2008, and December 2009, were included. Patients who were diagnosed
%U http://www.hindawi.com/journals/isrn.endocrinology/2013/893913/