The impact of automatic prescriptions on reducing low-density lipoprotein cholesterol levels

Compliance with the National Cholesterol Education Program (NCEP) guidelines for secondary prevention of atherosclerotic disease has been poor.

To determine whether an automatic prescription would improve compliance with NCEP guidelines on low-density lipoprotein (LDL) cholesterol for secondary prevention of atherosclerotic disease.

Observational study in which physicians chose whether to use an automatic prescription system.

126 patients with established coronary or cerebrovascular disease whose LDL cholesterol level was greater than 100 mg/dL.

By signing the automatic prescription, physicians allowed the study team (medical director and pharmacist) to change lipid-lowering medications. One member of the team then contacted the patient, advising him or her of any changes to medications and treatment. The patient was told that his or her doctor was recommending this change on the basis of recent laboratory tests.

The proportion of patients reaching the LDL cholesterol goal of 100 mg/dL or less.

Physicians used the automatic prescription for 25 patients. Eighteen of the 25 patients in the intervention group (72.0%) achieved the LDL cholesterol goal compared with only 43 of the 101 controls (42.6%) (P = 0.004). After adjustment for differences in age, sex, triglyceride levels, total cholesterol levels, high-density lipoprotein cholesterol levels, and preintervention LDL cholesterol levels, the likelihood of achieving the LDL cholesterol goal was 1.74 times higher in the automatic prescription group than in the control group (P = 0.025).

An automatic prescription can help physicians comply with the NCEP guidelines.