Table 4.
Adherence to National Quality Guidelines in the Overall Population and Persons with Serious Mental Illness (SMI)
| Measure | National Guidelines1 | Range of Guideline Adherence Rates in SMI Study Samples Reviewed | Estimated Guideline Adherence Rates in US Study Samples |
|---|---|---|---|
| INPATIENT TREATMENT OF ACUTE MYOCARDIAL INFARCTION (O’Gara et al., 2013) | |||
| Catheterization | Fibrinolytic treatment or angiogram with percutaneous coronary intervention or bypass surgery as needed | 5% – 47% | 76%–93% (McNamara et al., 2014; Shimony et al., 2014) |
| Thrombolytic therapy | 64% | 52.5% (Gibson et al., 2008) | |
| Coronary artery bypass grafting (CABG) | 2% – 20% | 9% (Shimony et al., 2014) | |
| Percutaneous transluminal coronary angioplasty (PTCA) | 9% – 33% | 43–69% (Shimony et al., 2014) | |
| GUIDELINES FOR TREATMENT FOLLOWING ACUTE MYOCARDIAL INFARCTION (O’Gara et al., 2013) | |||
| Aspirin/antiplatelet therapy | All patients should take aspirin/antiplatelet therapy barring clinical contraindication | 77% – 96% | 89%–94 (O’Brien et al., 2013) (McNamara et al., 2014) |
| Beta-blockers | All patients should take beta-blockers barring contraindication | 35% – 91% | 80–88% (O’Brien et al., 2013; Setoguchi et al., 2007) |
| Angiotensin converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) | All patients should take ACE inhibitors or ARBs barring clinical contraindication | 19% – 73% | 65%–77% (Goldberg et al., 2007a; McNamara et al., 2014; O’Brien et al., 2013) |
| Statins | All patients should take statins barring contraindication | 11% – 23% | 66%–85% (Fang et al., 2014; McNamara et al., 2014; O’Brien et al., 2013) |
| GUIDELINES FOR OUTPATIENT CARE AND TREATMENT OF CONGESTIVE HEART FAILURE (Yancy et al., 2013) | |||
| Left ventricular function (LVF) assessment | Staging and treatment for congestive heart failure should include left ventricular functional assessment (LVF) and medications in appropriate patients | 47% – 81% | 88%1 (Bertoni et al., 2004) |
| Angiotensin Converting Enzyme (ACE) Inhibitors or Angiotensin Receptor Blockers | 47% – 79% | 32–73%2 (Bertoni et al., 2004; Mosalpuria et al., 2014) | |
| Beta-Blockers | 46% | 38%–49% (Mosalpuria et al., 2014) | |
| GUIDELINES FOR OUTPATIENT CARE AND TREATMENT OF DIABETES MELLITUS (American Diabetes Association, 2014) | |||
| Diabetic eye examinations | Comprehensive eye examination at diagnosis and annually thereafter | 20% – 83% | 51%–75% (Ali et al., 2013a; National Committee on Quality Assurance, 2013; Paksin-Hall et al., 2013) |
| Diabetic foot examinations | Comprehensive foot examination annually | 78% – 87% | 65%–74% (Ali et al., 2013a; Paksin-Hall et al., 2013) |
| Glycosolated hemoglobin (HBA1c) testing | Monitoring of glycemic control at least two times per year in patients who are meeting treatment goals and at least quarterly in other patients | 43% – 89% | 87%–91% (National Committee on Quality Assurance, 2013) |
| Diabetic nephropathy testing | Annual screen for nephropathy | 50% – 79% | 78%–90% (National Committee on Quality Assurance, 2013) |
| Pharmacologic diabetes mellitus treatment | Pharmacologic treatment for those meeting elevated glycosylated hemoglobin criteria | 70% – 95% | 83–89% (Yeh et al., 2010) |
| GUIDELINES FOR CARE AND TREATMENT OF CO-MORBID CONDITIONS AMONG PERSONS WITH DIABETES MELLITUS (American Diabetes Association, 2014) | |||
| Lipid testing | Measure lipids at least annually | 26% – 77% | 76%–88% (Ali et al., 2013a) (National Committee on Quality Assurance, 2013) |
| Pharmacologic dyslipidemia treatment | Statin therapy should be used to treat diabetes mellitus in patients with cardiovascular disease and those aged 40 years and older with one or more cardiovascular risk factors | 52% – 67% | 51%–63% (Fu et al., 2011; Mann et al., 2009) |
| Angiotensin Converting Enzyme (ACE) Inhibitors or Angiotensin Receptor Blockers | For mild hypertension, initiate treatment with an ACE inhibitor/ARB if lifestyle therapy alone does not control hypertension for 3 months; for more severe hypertension, initiate treatment with an ACE inhibitor/ARB at time of diagnosis | 48% – 69% | 45%–64% (Ali et al., 2013b) |
| Aspirin | Aspirin treatment is indicated for patients at risk of cardiovascular disease | 36% | 63% (Akers et al., 2012) |
| ADHERENCE TO GUIDELINES FOR CARE AND TREATMENT OF DYSLIPIDEMIA3 (National Heart Lung and Blood Institute, 2002) | |||
| Pharmacologic dyslipidemia treatment | Initiate pharmacologic therapy if dietary therapy fails to lower lipids to recommended levels | 12% – 67% | 36%–39% (Mann et al., 2008) (Li et al., 2010) |
| ADHERENCE TO GUIDELINES FOR CARE AND TREATMENT OF HIV/AIDS3 (Aberg et al., 2009; Adults and Adolescents, 2009) | |||
| CD4 Count Monitoring | Monitor every 3–6 months in untreated patients to determine urgency of antiretroviral therapy initiation; monitor after treatment initiation to monitor response to antiretroviral therapy | 85% | 83% (Blair et al., 2011) |
| Viral Load Monitoring | Monitor every 3–6 months in untreated patients to determine urgency of antiretroviral therapy initiation; monitor after treatment initiation to monitor response to antiretroviral therapy | 82% | 83% (Blair et al., 2011) |
| Antiretroviral therapy4 | Antiretroviral therapy based on CD4 and viral load counts | 51%–83% | 85% (Blair et al., 2011) |
1
To the best of the authors’ knowledge, this single-state study is the only study to date measuring rates of left ventricular function assessment among individuals with congestive heart failure in the US
2
Limited studies of rates of angiotensin converting enzyme inhibitors or angiotensin receptor blockers among individuals with congestive heart failure in the US suggest that rates of medication use vary considerably across states.
3
Guidelines current as of date of literature evaluated for this review; guidelines have since been changed and updated.
4
Includes highly active antiretroviral therapy (HAART), protease inhibitors (PIs), and non-nucleoside reverse transcriptase inhibitors (NNRTIs)