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16 Médecine à l’acte/médecine au forfait – ANNEXES KCE Reports 85 S Indicateurs non retenus indicateurs nécessitant des données cliniques ou résultats de labo ou des données du dossier: The diagnosis of diabetes should be clearly identifiable on the electronic or paper records of all known diabetics. (2,3) Patiënten met diabetes staan als diabeticus genoteerd in de antecedentenlijst (structuurindicator) (22) Information about complication of diabetes is available either in the diabetes register, or otherwise in current aggregated form ( eg from a practice computer) (9) % of patients with long term glycaemia recorded in the notes in previous year (8) HbA1c control : percentage of patients with most recent HbA1c level > 9,0% (4) HbA1C controlled : < 6SD above normal population mean (target standard = 100%) (7) HbA1C controlled : < 4SD above normal population mean (target standard = 100%) (7) HbA1C controlled: < 9,1% . (target standard = 100%) (7) HbA1c controlled : < 7,5 % (target standard: 100%) (7) Percentage patiënten met diabetes mellitus met een HbA1c < 7,0% (26,29) Critères relatifs aux indicateurs d’impact : Résultat moyen ou bon du dernier dosage de l’HbA1c effectué au cours des 3 derniers mois (27,30) Het jaarlijks gemeten hemoglobinegehalte A1c is gelijk of lager dan 7% (uitkomstindicator) (23) Where the previous HbA1c was > 9, there is a record of HbA1c within the last 7 months (9) Over 80 years – offered treatment if average of last three readings shows diastolic pressure > 110 mm Hg or systolic pressure > 160 mm Hg and diastolic pressure > 100 mm Hg (9,12) If the HbA1c level of a diabetic patient is measured as > 8%, the following options should be offered: change in dietary or drug management; or explanation for raised test; or written record that higher target level is acceptable. (2,3) For patients aged under 70 ,if the last HbA1c was > 9, patient offered a therapeutic intervention aimed at improving glycaemic control (12) For patients aged under 75, if the last HbA1c was > 9, patient offered a therapeutic intervention aimed at improving glycaemic control (9) For patients aged over 70, if the last HbA1c was > 10, patient offered a therapeutic intervention aimed at improving glycaemic control (12) For patients aged over 75 or over, if the last HbA1c was > 10, patient offered a therapeutic intervention aimed at improving glycaemic control (9) Record of results of HbA1c test and blood glucose test at least once every year for diabetic patients. (1) Percentage of patients with most recent blood pressure < 140/90 mmHg (4) If a diabetifc has a sustained BP recorded as >140/85 mmHg on 3 or more consecutive occasions then a change in non-drug or drug management should be offered. (2,3)
KCE Reports 85 S Médecine à l’acte/médecine au forfait – ANNEXES 17 Diabetic patients with BP > 140/85 mmHg should have their blood pressure remeasured within 3 months. (2,3) Het persisteren van een bloeddruk va meer dan 130/80 mmHg gaat gepaard met een verandering in beleid (dieet, medicatie…) (procesindicator) (23) Under 80 years – offered treatment if average of last three readings shows diastolic pressure > 100 mm Hg or systolic pressure > 150 mm Hg and diastolic pressure > 90 mm Hg (9,12) Record of blood pressure measurement at least once every 6 months for diabetic patients (1) Past 14 month, record of Blood Pressure (11) Diabetes quality indicator : BP < 130/80 mm Hg (29) % of those identified with diabetes mellitus whose most recent systolic BP is < 160 mm Hg (15) % of those identified with diabetes mellitus whose most recent diastolic BP is < 90 mm Hg (15) Critères relatifs aux indicateurs de processus : Contrôle de la TA au cours des 3 derniers mois (27,30) Uit het patientendossier blijkt dat driemaandelijks bloeddruk gemeten wordt (22) All diabetic patients should receive an annual review covering : blood pressure (10) Recording of risk factors: Blood Pressure (target standards: 100%) (7) In the 14 months, record that refferal to an ophtalmologist where there is evidence of significant macular oedema, moderate or severe non-proliferative retinopathy, or any proliferative retinopathy (9) Record of an examination of legs and feet, including peripheral pulses, for diabetic patients at least once every 2 years. Pour (7) , target standards = 100%. (1,7) Diabetics should have their feet examined at least once every 12 months. Pour (7), target standards = 100%. (2,3,7,10) % of diabetic with feet sensation checked in last year (11) Past 14 months, record of recording of peripheral pulses or record of visual examination of the feet (12). Past 14 months record of recording of peripheral pulses (9,16) Past 14 months record of record of vibration sense (16) Past 14 months record of vibration sense or pinprick or monofilament testing (9) Uit het patientendossier blijkt dat jaarlijks voeten nagekeken worden (procesindicator) (22) Past 14 months record of : visual examination of the feet (for ulceration or deformity (9)) (9,16) Percentage of patients receiving at least one foot exam annually (4) If there is evidence of foot deformities, history of foot ulceration, significant vascular or neuropathic disease the patient should be referred to an approppriate service, if not already under their care. (2,3) In the last 14 months record of the refferal to a specialist clinic where there is foot ulcer (9)
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KCE reports 1. Efficacité et renta
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74. Oxygénothérapie Hyperbare: Ra
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