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Using paper chart based clinical reminders to improve guideline adherence to lipid management
Chi-Sheng Hung1, Jou-Wei Lin, Juey-Jen Hwang
1Cardiovascular Center, National Taiwan University Hospital Yun-Lin Branch, Dou-Liou City, Yun-Lin, Taiwan.
Insights
A paper-based clinical reminder improved doctor attention to lipid levels in coronary heart disease patients. However, it did not increase lipid-lowering therapy prescriptions due to local policy constraints.
Area of Science:
- Cardiology
- Clinical Practice Improvement
- Health Informatics
Background:
- Adherence to lipid guidelines is crucial for managing coronary heart disease (CHD).
- Clinical reminders can potentially improve physician adherence to best practices.
- Previous interventions have shown mixed results in improving lipid management.
Purpose of the Study:
- To evaluate the effectiveness of a paper-based clinical reminder in enhancing adherence to lipid guidelines among CHD patients.
- To assess the impact of the reminder on initiating lipid-lowering therapy (LLT) and lipid profile checks.
Main Methods:
- A randomized controlled trial was conducted with CHD patients not on LLT.
- A paper chart reminder detailing current standards and insurance policy was implemented in the intervention group.
- The primary outcome was new LLT prescription, and the secondary outcome was LLT or lipid profile check-up within 6 months.
Main Results:
- The study included 92 patients in the reminder group and 102 in the control group.
- No significant difference was observed in new LLT prescriptions between groups (primary outcome).
- The secondary outcome (composite of LLT or lipid profile check-up) was significantly higher in the reminder group (OR: 2.81, P = 0.001).
Conclusions:
- Paper-based clinical reminders can influence physician behavior and increase attention to patient lipid levels.
- Despite improved attention, the reminder did not translate to increased LLT initiation or reduced LDL levels.
- Local policy constraints may limit the clinical impact of such reminders on therapeutic interventions.
Rationale, Aims And Objectives:
The objective of this study was to apply a paper-based clinical reminder to improve the adherence to lipid guidelines.
Methods:
Patients with coronary heart disease (CHD) without lipid-lowering therapy (LLT) were recruited, and medical records were reviewed. Eligible subjects were randomized; a clinical reminder stating current standards and local insurance policy was stamped on the paper chart in the study group but not in the control. The primary outcome was new LLT subscription in the 6-month follow-up period, and the secondary end point was the composite result of LLT or lipid profile check-up.
Results:
Ninety-two patients were assigned to the study group and 102 to the control group. The primary outcome showed no difference at the end of 6 months (OR: 1.70, P = 0.248, 95% CI: 0.69-4.19). The secondary end point was significantly higher in the reminder group (OR: 2.81, P = 0.001, 95% CI: 1.57-5.04).
Conclusion:
A paper chart based clinical reminder providing update clinical recommendations could modify the doctor's behaviour and improve the attention to lipid levels. However, its effect cannot be transformed into an increase in LLT or a decrease in low-density lipoprotein level owing to local policy constraint.
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