Nurse-Mediated Cholesterol Management Compared With Enhanced Primary Care in Siblings of Individuals With Premature Coronary Disease

Becker, Diane M.; Raqueño, Judith V.; Yook, Raphael M.; Král, B; Blumenthal, Roger S.; Moy, Taryn F.; Bezirdjian, Pamela J.; Becker, Lewis C.

doi:10.1001/archinte.158.14.1533

Cited by 76 publications

(50 citation statements)

References 35 publications

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“…While there have been publications (22,23) of well-conducted and controlled trials examining the benefits of a nurse-managed approach in dyslipidemia, the present study unfortunately did not provide support for this type of approach in the follow-up and management of patients post-MI. This result of the present study was at variance with that of our previously published data (15) on an albeit small pilot project that was uncontrolled and conducted at a time when guidelines for lowering plasma lipid levels in secondary prevention were not as strongly supported as they are currently.…”

Section: Discussioncontrasting

confidence: 80%

Surveillance and treatment of dyslipidemia in the post-infarct patient: Can a nurse-led management approach make a difference?

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et al. 2006

Canadian Journal of Cardiology

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Section: Discussioncontrasting

confidence: 80%

Surveillance and treatment of dyslipidemia in the post-infarct patient: Can a nurse-led management approach make a difference?

Lapointe

Lepage

Larrivée

et al. 2006

Canadian Journal of Cardiology

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“…Approaches similar to ours may also improve management for other disorders such as hypertension and dyslipidemia, where provider action is frequently inadequate and not symptom driven (21,22). In this regard, we believe that the emphasis should be on changing provider behavior (25,26,(32)(33)(34)(35)(36)(37)(38)(39)(40)43).…”

Section: A1c Outcomes In the Intervention Site Versus Other Primary Cmentioning

confidence: 81%

“…We have designated the latter problem as clinical inertia (20), which may limit control of hypertension (21) and dyslipidemia (22) as well as diabetes (23)(24)(25)(26)(27). At Grady Memorial Hospital in Atlanta, there was more clinical inertia and A1C levels were higher in the general medicine primary care clinic as compared with the diabetes specialty clinic (28).…”

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confidence: 99%

An Endocrinologist-Supported Intervention Aimed at Providers Improves Diabetes Management in a Primary Care Site

et al. 2005

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OBJECTIVE -Management of diabetes is frequently suboptimal in primary care settings, where providers often fail to intensify therapy when glucose levels are high, a problem known as clinical inertia. We asked whether interventions targeting clinical inertia can improve outcomes. RESEARCH DESIGN AND METHODS -A controlled trial over a 3-year period was conducted in a municipal hospital primary care clinic in a large academic medical center. We studied all patients (4,138) with type 2 diabetes who were seen in continuity clinics by 345 internal medicine residents and were randomized to be control subjects or to receive one of three interventions. Instead of consultative advice, the interventions were hard copy computerized reminders that provided patient-specific recommendations for management at the time of each patient's visit, individual face-to-face feedback on performance for 5 min every 2 weeks, or both.RESULTS -Over an average patient follow-up of 15 months within the intervention site, improvements in and final HbA 1c (A1C) with feedback ϩ reminders (⌬A1C 0.6%, final A1C 7.46%) were significantly better than control (⌬A1C 0.2%, final A1C 7.84%, P Ͻ 0.02); changes were smaller with feedback only and reminders only (P ϭ NS vs. control). Trends were similar but not significant with systolic blood pressure (sBP) and LDL cholesterol. Multivariable analysis showed that the feedback intervention independently facilitated attainment of American Diabetes Association goals for both A1C and sBP. Over a 2-year period, overall glycemic control improved in the intervention site but did not change in other primary care sites (final A1C 7.5 vs. 8.2%, P Ͻ 0.001).CONCLUSIONS -Feedback on performance aimed at overcoming clinical inertia and given to internal medicine resident primary care providers improves glycemic control. Partnering generalists with diabetes specialists may be important to enhance diabetes management in other primary care settings. Diabetes Care 28:2352-2360, 2005T ype 2 diabetes is a public health pandemic with devastating impact on morbidity, mortality, and cost. In the U.S., the prevalence of diabetes increased from 4.9% of the population in 1990 to 7.9% in 2001 (1-4), and prevalence is projected to rise to 30 million Americans in 2030 (5). The lifetime risk of diabetes is currently projected at 33 and 38% for American men and women, respectively, born in 2000 (6), with accompanying decrease in life expectancy (6 -8). Diabetes increases the risk of both microvascular (9,10) and macrovascular disease (11), and diabetes is now the sixth leading cause of death in the U.S (12). Diabetes accounted for ϳ11% of total U.S. health care expenditures in 2002 ($92 billion) (13), but better metabolic control can reduce costs (14).Most diabetes management in the U.S. takes place in primary care settings, where measures of both process and outcome indicate that care is often suboptimal. Surveys in the early 1990s revealed that many Medicare beneficiaries had limited evaluation of levels of HbA 1c (A1C), cholesterol, o...

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“…TI impacts not only control of BP but of other chronic diseases, including diabetes mellitus and hyperlipidemia. [17][18][19][20][21][22][23][24] Although data suggest that TI contributes to the high prevalence of uncontrolled hypertension, the quantitative impact is not clear. This article examines the impact of TI on failing to control hypertension in Ն70% of treated patients.…”

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confidence: 99%

Therapeutic Inertia Is an Impediment to Achieving the Healthy People 2010 Blood Pressure Control Goals

et al. 2006

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Abstract-Therapeutic inertia (TI), defined as the providers' failure to increase therapy when treatment goals are unmet, contributes to the high prevalence of uncontrolled hypertension (Ն140/90 mm Hg), but the quantitative impact is unknown. To address this gap, a retrospective cohort study was conducted on 7253 hypertensives that had Ն4 visits and Ն1 elevated blood pressure (BP) 1999 -2000. 2,3 Despite an increase in the number and tolerability of antihypertensive medications, goal BP has been difficult to attain. Clinical trials, including the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack trial, 4 with 66% control rates and the Controlled Onset Verapamil Investigation of Cardiovascular Endpoints study 5 with 70% control rates have shown that the BP control rates reported in national data can be substantially improved. Of note, the majority of uncontrolled hypertensive subjects in the United States are older individuals with systolic BP (SBP) 140 to 159 mm Hg who are seen an average of 6 times annually in a primary care setting. 6 Even with substantial reductions in the number of unaware and untreated hypertensive patients, controlling BP in Ն70% of treated patients is a vital component of reaching the Healthy People 2010 goal of controlling hypertension in 50% of all affected patients. 7 Hypertension control rates nearly tripled from 10% in 1976 -1980 to 29% in 1988 -1991. 8 The improvements in hypertension control coincided temporally with a large decline in the age-adjusted rates for stroke and coronary heart disease (CHD).Unfortunately, BP control rates have changed little in the past 15 years, especially in women. Patient factors, such as compliance, 9,10 knowledge, 11 and lack of insurance, 12 and system factors, such as limited access to care and medications 13 and lack of appointment reminders, 14 have been cited for the low rates of BP control. Of note, BP control remains suboptimal in systems such as the Veterans Administration where financial barriers to health care are less. 15,16 Physician factors, such as therapeutic inertia (TI), that is, failure of providers to begin new medications or increase dosages of existing medications when an abnormal clinical parameter is recorded, are becoming more evident. TI represents a significant barrier to better hypertension control. TI impacts not only control of BP but of other chronic diseases, including diabetes mellitus and hyperlipidemia. [17][18][19][20][21][22][23][24] Although data suggest that TI contributes to the high prevalence of uncontrolled hypertension, the quantitative impact is not clear. This article examines the impact of TI on

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Nurse-Mediated Cholesterol Management Compared With Enhanced Primary Care in Siblings of Individuals With Premature Coronary Disease

Cited by 76 publications

References 35 publications

Surveillance and treatment of dyslipidemia in the post-infarct patient: Can a nurse-led management approach make a difference?

Surveillance and treatment of dyslipidemia in the post-infarct patient: Can a nurse-led management approach make a difference?

An Endocrinologist-Supported Intervention Aimed at Providers Improves Diabetes Management in a Primary Care Site

Therapeutic Inertia Is an Impediment to Achieving the Healthy People 2010 Blood Pressure Control Goals

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