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18 Médecine à l’acte/médecine au forfait – ANNEXES KCE Reports 85 S In the last 14 months, record of referral to a chiropodist where feet are “at risk” (age over 65, immobility, nephropathy, retinopathy, < 2 foot pulses) (9) Critères relatifs aux indicateurs de processus : Inspection des pieds au cours des 3 derniers mois (27,30) Diabetes quality indicator : foot exam in the previous 12 months (29) Diabetic management : annual foot examination (28) Record of diabetes management education information for patients with diabetes. (1) The record show that each newly diagnosed patient or carer has been offered education about diabetes management (9) Adequate patient information should be available in a suitable format for patient self-management of diabetes (10) Past 5 years record of : documentation of education about diabetes (12) All diabetic patients should have weight record every 6 months (1) Past 14 months, record of weight (9,12) Recording of risk factors: Weight/BMI (targeted standards: 100%) (7) Uit het patientendossier blijkt dat driemaandelijks BMI bepaald wordt (procesindicator) (22) The patient has been given advice about weight reduction or reffered to a dietician where the patient is obese or has a BMI of > 27 (9) Critères relatifs aux indicateurs de processus : Contrôle du poids du patient au cours des 3 derniers mois (27,30) 80% diabetic patients (insulin dependant and NIDDM) reviewed in past year (10) % of patients seen for follow-up (8) Diabetic patients should be seen by an appropriate health care professionnel (GP, Practice nurse, Diabetic Dr) annually. (2,3) Critères relatifs aux indicateurs de processus : Prochain rendez-vous prévu dans les 3 mois (27,30). LDL cholesterol control: percentage of patient with most recent LDL < 130 mg/dl (4) If the total cholesterol is > 7,8 (or > 6,4 in patients who have evidence of ischaemic heart disease), lipid lowering treatment has been offered or intensified (9) Diabetic patients with established Ischeamic Heart Disease and a raised fasting cholesterol (>=5 mmol/L) should be advised about dietary modification, or take lipid lowering medication. (2,3) En LDL-cholesterol van meer dan 130 mg/dL gaat gepaard met het gebruik van lipidenverlagers (procesindicator) (23) Diabetes quality indicator : LDL cholesterol < 100 mg/dL (29) % patients with microalbuminaemia not on ACE inhibitor (11) If patient is being treated for hypertension and has proteinuria (macroalbuminuria but not microalbuminuria), the patient is taking an angiotensin converting enzyme inhibitor (9,12)
KCE Reports 85 S Médecine à l’acte/médecine au forfait – ANNEXES 19 Diabetic patients with sustained proteinuria should be currently prescribed treatment with ACE inhibitors unless contraindicated. (2,3) % albumin/creatinine ratio (ACR) in last year (11) Bij het persisteren van micro-albuminurie wordt een ACE-inhibitor ingeschakeld, tenzij er contra-indicaties bestaan (procesindicator) (23) Refferal to a specialist if serum creatinine is > 200 mmol/l (9:, record in the 14 months that …) (9,12) Critères relatifs aux indicateurs d’impact : Absence de microalbuminurie au cours des 12 derniers mois écoulés (27,30) % patients with creatinine > 0,150 on metformine or glibenclamide (11) Past 14 months, record of hypoglycaemia symptoms if patient taking sulphonylurea (9,12) Past 5 years record of smoking status (12) Past 5 years, there is a record of smoking status in the notes (9) Percentage of patients whose smoking status was ascertained and documented annually (4) Past 5 years record of advice given on smoking cessation to smokers (for type 2 diabetes mellitus) (9,12) The records contain details, recorded within the last 14 months of: any comment about general wellbeing (9) Een klachtenlijst wordt regelmatig doorlopen: er wordt minstens een keer per jaar navraag gedaan naar therapietrouw, lichaamsbeweging, sumptomen van hypo- en hyperglycemie, moeilijkheden met dieet, het krijgen van gezondheidseducatie. (23) Uit het patientendossier blijkt dat driemaandelijks klachtenlijst overlopen werd (22) De diabetesmedicatie staat exact genoteerd in het dossier (structuurindicator) (23) De diagnose diabetes is correct: (nuchtere glycemie op veneus bloed >125 mg%) (22) Critères relatifs aux indicateurs de processus : Utilisation d’un journal pour le suivi du diabète (27,30) All diabetic patients should receive an annual review covering : cardiovascular risk factors (10) Where the patient undertakes blood or urine monitoring, there is record of the results of home testing in the past 14 months (9) The records show whether the patient’s glycaemic control is being monitored by urine or blood test (9) examens complémentaires réalisables au cabinet, sans facturation spécifique : All diabetic patients should receive an annual review covering : glycaemic control (10) Uit het patientendossier blijkt dat driemaandelijks nuchtere glycemie gecontroleerd wordt (procesindicator) (22) Percentage of diabetic for which blood glucose is investigated (8)
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KCE reports 1. Efficacité et renta
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74. Oxygénothérapie Hyperbare: Ra
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