Diabetes Care in Extended-Care Facilities
Appropriate intensity of care?
- Rachel M. Holt, OMSII1,
- Frank L. Schwartz, MD12 and
- Jay H. Shubrook, DO12
- 1Ohio University College of Osteopathic Medicine, Athens, Ohio
- 2Appalachian Rural Health Institute Diabetes Center, Athens, Ohio
- Address correspondence and reprint requests to Rachel M. Holt, OMSII, Cornwell Center, 65 Hospital Dr., Athens, OH 45701. E-mail: rh185305{at}ohio.edu
Abstract
OBJECTIVE—The American Diabetes Association (ADA) does not recognize different treatment goals for the institutionalized adult compared with the outpatient adult with diabetes, nor has it outlined specific recommendations for this population. The purpose of this study was to examine physician management of patients with type 1 and type 2 diabetes residing in extended-care facilities and to compare this management with ADA standards of care for the outpatient adult.
RESEARCH DESIGN AND METHODS—This retrospective chart review included data from 108 residents with type 1 or type 2 diabetes at 11 extended health care facilities in the Midwestern U.S. and included a review of the medical problem list, medication list, laboratory reports, and all physician and consultation notes during the study period.
RESULTS—Blood glucose was monitored in 98% of the subjects, and 38% met glucose goals. A1C goal was achieved in 67% of patients. Blood pressure was monitored in 94% of patients, with 55% meeting goal. Thirty-one percent of patients had yearly lipids checked, 37% had annual electrocardiograms, 7% had urine analyzed for microalbuminuria, 42% were on aspirin, 87% received foot exams, 42% received dilated eye exams, 89% received influenza vaccinations, and 46% received pneumoccocal vaccinations.
CONCLUSIONS—Care of the institutionalized elderly with diabetes fails to meet ADA standards of care for the outpatient adult. Separate practice guidelines are needed for people with diabetes who reside in extended care facilities in order to improve quality and consistency of care.
Footnotes
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Published ahead of print at http://care.diabetesjournals.org on 10 March 2007. DOI: 10.2337/dc06-2311.
A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.
The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked “advertisement” in accordance with 18 U.S.C. Section 1734 solely to indicate this fact.
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- Accepted February 20, 2007.
- Received November 10, 2006.
- DIABETES CARE
