04 Nov Electronic Records Can Provide Real World Evidence On Treatments of Type 2 Diabetes
MedicalResearch.com Interview with:
Lee Kallenbach, PhD, MPH
MedicalResearch.com: What is the background for this study?
Response: Clinical inertia, or the tendency for patients and providers to continue using the same course of treatment even when clinical markers may suggest that treatment intensification is necessary, is an ongoing factor that can contribute to inadequate diabetes care. This is especially true when the treatment intensification may involve a switch from an oral medication to an injectable medication. It is less challenging for a patient to take a pill than it is to give themselves a shot.
Even with all the new diabetes treatments available, clinical inertia is still common among patients with uncontrolled type 2 diabetes (T2D). To further understand the extent of clinical inertia among patients with T2D, the study assessed treatment intensification patterns and associated demographic and clinical characteristics for patients with uncontrolled T2D who were already taking two or more oral anti-diabetes medications.
The study consisted of a retrospective observational analysis leveraging data from Practice Fusion’s de-identified clinical database, which includes more than 38 million records, representing 6.7 percent of all practices across the United States.1 Using a cohort of 25,365 de-identified records, we studied the care given by providers in independent practices to patients in need of intensifying their antidiabetic therapy for managing T2D. To our knowledge, this is one of the largest real world evidence (RWE) studies of T2D that has leveraged a de-identified clinical database from an electronic health record (EHR) platform.
MedicalResearch.com: What are the main findings?
Response: The study results showed that 71.7% (n = 18,197) of patients on two or more oral anti-diabetes medications with uncontrolled HbA1c levels had no change in therapy.
● When patients intensified therapy, most added an additional oral anti-diabetes medication.
● Intensification to injectable forms of therapy was infrequent, occurring less than 10% of the time. Injectable medications include insulin or a glucagon-like peptide-1 receptor agonist.
MedicalResearch.com: What should readers take away from your report?
Response: The study results showed that providers in independent practices that utilize Practice Fusion’s EHR platform provided similar care to those in other care settings (as reported in other studies), when managing patients with T2D. These results help validate and elucidate treatment patterns observed in data from other relevant sources such as clinical studies reported in peer-reviewed journals.
More broadly, this study demonstrates the powerful insights that can be derived from a de-identified clinical database sourced from an EHR platform. RWE data derived from a de-identified clinical databases sourced from an EHR platform can provide novel insights into areas such as epidemiology, comparative effectiveness, adherence and costs to supplement our understanding derived from results learned from randomized clinical trial studies.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Response: A companion issue to look at would be how long patients with T2D stay on injectable therapy after they start on that treatment course. From other studies, we know many patients stop taking their injectable medication soon after it is started, so it would be of benefit to further validate this understanding using RWE-based data. Longer term, we would like to derive additional clinical insights from the study by looking at the outcomes of these patients based on treatment type. Did patients who received treatment intensification have fewer complications from T2D? If so, was there healthcare resource utilization lower?
Additionally, it would be worthwhile to explore the effects of clinical decision support programs for T2D treatment intensification, which can include messaging providers within their EHR if their patient(s) meet the specified clinical criteria for treatment intensification based on consensus, evidence-based clinical guidelines. As a provider, having easy access to salient health information about a patient within the EHR, supported by access to consensus, evidence-based clinical guidelines, can help empower that provider in his or her clinical decision-making as well as help that provider give even more individualized care to the patient. We have already seen positive results achieved with these types of clinical decision support alert programs in other therapeutic areas, such as vaccines.
MedicalResearch.com: Is there anything else you would like to add?
Response: What’s unique about Practice Fusion’s RWE offerings is that not only can they be used to aggregate data and perform retrospective studies utilizing our de-identified clinical database, but they can also be used to conduct studies that incorporate providers’ input at the point of care. To our knowledge, no other EHR platform currently offers this capability. We look forward to potentially expanding the use of Practice Fusion’s EHR platform to further elucidate optimal care for patients with diabetes.
1SK&A, Report on Physician Office Usage of Electronic Healthcare Records Software (February 2016). http://www.skainfo.com/reports/physician-ehr-software-usage
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Real World Evidence Study on Treatments of Type 2 Diabetes
Disclosure: Study supported by Practice Fusion
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