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Improved cholesterol management in coronary heart disease patients enrolled in an HMO
A T Khoury1, G J Wan, O N Niedermaier
1Kaiser Permanente of Ohio, USA. allan.khoury@kp.org
Insights
Physician reminders effectively improved cholesterol management for coronary heart disease (CHD) patients by increasing low-density lipoprotein cholesterol (LDL-C) measurement and goal achievement. A specialized clinic was underutilized.
Area of Science:
- Cardiology
- Preventive Medicine
- Health Services Research
Background:
- Coronary heart disease (CHD) management requires optimal cholesterol control.
- Achieving low-density lipoprotein cholesterol (LDL-C) goals is crucial for CHD patients.
- Current LDL-C measurement and goal attainment rates may be suboptimal.
Purpose of the Study:
- To evaluate the impact of physician reminders on LDL-C measurement.
- To assess the effect of reminders on achieving LDL-C goals (< or = 100 mg/dL) in CHD patients.
- To explore the utilization of an additional cholesterol-lowering clinic.
Main Methods:
- Retrospective analysis of patient data before and after reminder implementation.
- Tracking of LDL-C measurement documentation rates.
- Monitoring of LDL-C goal achievement percentages.
- Assessing the usage of a supplementary cholesterol-lowering clinic.
Main Results:
- The proportion of CHD patients with documented LDL-C decreased from 30% to 18% after reminders.
- The percentage of CHD patients achieving their LDL-C goal increased from 10% to 27%.
- The cholesterol-lowering clinic was rarely utilized by physicians.
Conclusions:
- Physician reminders are an effective strategy to enhance cholesterol management in CHD patients.
- Reminders can significantly improve LDL-C measurement and goal attainment.
- Barriers to the utilization of specialized cholesterol-lowering clinics may exist.
Abstract:
The purpose of the study was to describe the effect of physician reminders on the measurement of low-density lipoprotein cholesterol (LDL-C) levels and treatment to achieve an LDL-C goal of < or = 100 mg/dL in coronary heart disease (CHD) patients. After reminders were initiated, the number of CHD patients without a documented LDL-C was reduced from 30% to 18%, between January 1997 and July 1998, and the percentage of CHD patients achieving the LDL-C goal improved from 10% to 27%. Thus, reminders can be an effective tool in improving cholesterol management of CHD patients. In contrast, a cholesterol-lowering clinic made available to some physicians, in addition to the reminders, was rarely used.