Electronic Alerts Versus On-Demand Decision Support to Improve Dyslipidemia Treatment

Wyk, Jacobus T. van; Wijk, Marc A. M. van; Sturkenboom, Miriam; Mosseveld, Mees; Moorman, Peter W.; Lei, Johan van der

doi:10.1161/circulationaha.107.697201

Cited by 111 publications

(125 citation statements)

References 26 publications

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“…Most participants had a regular source of care in this study, however, and adjusting for this characteristic did not explain race‐sex differences in statin use or LDL‐C control. Screening can improve treatment rates,32 but we were unable to evaluate the effect of LDL‐C measurement. Differences in recall of high‐cholesterol diagnosis across race‐sex groups could also stem from low healthcare provider recognition or suboptimal communication of hyperlipidemia by providers 33.…”

Section: Discussionmentioning

confidence: 99%

Race‐Sex Differences in Statin Use and Low‐Density Lipoprotein Cholesterol Control Among People With Diabetes Mellitus in the Reasons for Geographic and Racial Differences in Stroke Study

Gamboa

Colantonio

Brown

et al. 2017

JAHA

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BackgroundStatin therapy is a cornerstone of cardiovascular disease risk reduction for people with diabetes mellitus. Past reports have shown race‐sex differences in statin use in general populations, but statin patterns by race and sex in those with diabetes mellitus have not been thoroughly studied.Methods and ResultsOur sample of 4288 adults ≥45 years of age with diagnosed diabetes mellitus who had low‐density lipoprotein cholesterol (LDL‐C) >100 mg/dL or were taking statins recruited for the Reasons for Geographic and Racial Differences in Stroke study from 2003 to 2007. Exposures included race‐sex groups (white men [WM], black men [BM], white women [WW], black women [BW]) and factors that may influence healthcare utilization. Proportions and prevalence ratios were calculated for statin use and LDL‐C control. Statin use for WM, BM, WW, and BW was 66.0%, 57.8%, 55.0%, and 53.6%, respectively (P<0.001). After adjustment for healthcare utilization factors, statin use was lower for BM, WW, and BW compared with WM (prevalence ratios [95%CI]: 0.96 [0.89‐1.03], 0.86 [0.80‐0.92], and 0.87 [0.81‐0.93], respectively, P<0.001). LDL‐C control among those taking statins for WM, BM, WW, and BW was 75.3%, 62.7%, 69.0%, and 56.0%, respectively (P<0.001). After adjustment, LDL‐C control was lower for BM, WW, and BW compared with WM (prevalence ratios [95%CI]: 0.85 [0.79‐0.93], 0.89 [0.82‐0.96], and 0.73 [0.67‐0.80], respectively, P<0.001).ConclusionsRace‐sex disparities in statin use and LDL‐C control were only partly explained by factors influencing health services utilization. Healthcare provider awareness of these disparities may help to close the observed race‐sex gaps in statin use and LDL‐C control among people with diabetes mellitus.

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Section: Discussionmentioning

confidence: 99%

Race‐Sex Differences in Statin Use and Low‐Density Lipoprotein Cholesterol Control Among People With Diabetes Mellitus in the Reasons for Geographic and Racial Differences in Stroke Study

Gamboa

Colantonio

Brown

et al. 2017

JAHA

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“…Computerized clinical decision support has been used successfully to promote guidelinebased treatment of dyslipidemia in primary care. 26 Future studies should aim to determine the optimal combination of quality improvement techniques.…”

Section: Discussionmentioning

confidence: 99%

Electronic Health Record-Based Patient Identification and Individualized Mailed Outreach for Primary Cardiovascular Disease Prevention: A Cluster Randomized Trial

et al. 2012

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BACKGROUND: Many individuals at higher risk for cardiovascular disease (CVD) do not receive recommended treatments. Prior interventions using personalized risk information to promote prevention did not test clinic-wide effectiveness. OBJECTIVE AND DESIGN: To perform a 9-month cluster-randomized trial, comparing a strategy of electronic health record-based identification of patients with increased CVD risk and individualized mailed outreach to usual care. PARTICIPANTS: Patients of participating physicians with a Framingham Risk Score of at least 5 %, lowdensity lipoprotein (LDL)-cholesterol level above guideline threshold for drug treatment, and not prescribed a lipid-lowering medication were included in the intention-to-treat analysis. INTERVENTION: Patients of physicians randomized to the intervention group were mailed individualized CVD risk messages that described benefits of using a statin (and controlling hypertension or quitting smoking when relevant). MAIN MEASURES: The primary outcome was occurrence of a LDL-cholesterol level, repeated in routine practice, that was at least 30 mg/dl lower than prior. A secondary outcome was lipid-lowering drug prescribing. Clinicaltrials.gov identifier: NCT01286311. KEY RESULTS: Fourteen physicians with 218 patients were randomized to intervention, and 15 physicians with 217 patients to control. The mean patient age was 60.7 years and 77% were male. There was no difference in the primary outcome (11.0 % vs. 11.1 %, OR 0.99, 95 % CI 0.56-1.74, P=0.96), but intervention group patients were twice as likely to receive a prescription for lipid-lowering medication (11.9 %, vs. 6.0 %, OR 2.13, 95 % CI 1. 05-4.32, p=0.038). In post hoc analysis with extended follow-up to 18 months, the primary outcome occurred more often in the intervention group (22.5 % vs. 16.1 %, OR 1.59, 95 % CI 1.05-2.41, P=0.029). CONCLUSIONS: In this effectiveness trial, individualized mailed CVD risk messages increased the frequency of new lipid-lowering drug prescriptions, but we observed no difference in proportions lowering LDL-cholesterol after 9 months. With longer follow-up, the intervention's effect on LDL-cholesterol levels was apparent.

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“…Although this strategy should theoretically be effective for quality improvement, the results of empiric studies have been mixed, even if multiple reminders are sent or the reminders are delivered electronically. [15][16][17][18][19][20][21][22][23][24][25][26][27][28] However, point-of-care evidence reminders such as the ones we used have been reported to have a more substantial effect when coupled with an alerting element that "pushes" the clinician to change prescribing. [26][27][28] For example, we were previously able to significantly improve bisphosphonate use among patients with osteoporosis by use of faxed opinion leader statements that were identical in format to those used in this study.…”

Section: Discussionmentioning

confidence: 99%

“…Finally, unlike prior studies of point-of-care reminders endorsed by specialists or local opinion leaders, [15][16][17][18][19][20][21][22][23][24][25][26][27][28] our inclusion of 2 intervention arms in the ESP-CAD study permits us to disentangle the effect of local opinion leaders from that of the evidence statements (i.e., to separate the messenger from the message). We observed a greater effect of evidence statements that were endorsed by local opinion leaders compared with the anonymous (but otherwise identical) unsigned statements, although the 6% absolute difference was not statistically significant.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

The Enhancing Secondary Prevention in Coronary Artery Disease trial

McAlister¹,

Fradette²,

Majumdar³

et al. 2009

Canadian Medical Association Journal

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Background: Proven efficacious therapies are sometimes underused in patients with chronic cardiac conditions, resulting in suboptimal outcomes. We evaluated whether evidence summaries, which were either unsigned or signed by local opinion leaders, improved the quality of secondary prevention care delivered by primary care physicians of patients with coronary artery disease. Methods:We performed a randomized trial, clustered at the level of the primary care physician, with 3 study arms: control, unsigned statements or opinion leader statements. The statements were faxed to primary care physicians of adults with coronary artery disease at the time of elective cardiac catheterization. The primary outcome was improvement in statin management (initiation or dose increase) 6 months after catheterization. Results:We enrolled 480 adults from 252 practices. Although statin use was high at baseline (n = 316 [66%]), most patients were taking a low dose (mean 32% of the guideline-recommended dose), and their low-density lipoprotein (LDL) cholesterol levels were elevated (mean 3.09 mmol/L). Six months after catheterization, statin management had improved in 79 of 157 patients (50%) in the control arm, 85 of 158 (54%) patients in the unsigned statement group (adjusted odds ratio [OR] 1.18, 95% CI 0.71-1.94, p = 0.52) and 99 of 165 (60%) patients in the opinion leader statement group (adjusted OR 1.51, 95% CI 0.94-2.42, p = 0.09). The mean fasting LDL cholesterol levels after 6 months were similar in all 3 study arms: 2.35 (standard deviation [SD] 0.86) mmol/L in the control arm compared with 2.24 (SD 0.73) among those in the opinion leader group (p = 0.48) and 2.19 (SD 0.68) in the unsigned statement group (p = 0.32).Interpretation: Faxed evidence reminders for primary care physicians, even when endorsed by local opinion leaders, were insufficient to optimize the quality of care for adults with coronary artery disease. ClinicalTrials.gov trial register no. NCT00175240. AbstractPreviously published at www.cmaj.ca

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Electronic Alerts Versus On-Demand Decision Support to Improve Dyslipidemia Treatment

Cited by 111 publications

References 26 publications

Race‐Sex Differences in Statin Use and Low‐Density Lipoprotein Cholesterol Control Among People With Diabetes Mellitus in the Reasons for Geographic and Racial Differences in Stroke Study

Race‐Sex Differences in Statin Use and Low‐Density Lipoprotein Cholesterol Control Among People With Diabetes Mellitus in the Reasons for Geographic and Racial Differences in Stroke Study

Electronic Health Record-Based Patient Identification and Individualized Mailed Outreach for Primary Cardiovascular Disease Prevention: A Cluster Randomized Trial

The Enhancing Secondary Prevention in Coronary Artery Disease trial

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