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Primary Care Clinical Volumes, Cholesterol Testing, and Cardiovascular Outcomes.

Jacob A Udell1, Arielle R Brickman2, Anna Chu3

  • 1Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada; Cardiovascular Division, Department of Medicine, Women's College Hospital, Toronto, Ontario, Canada; Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada; Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada.

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Primary care physician clinical volume impacts cardiovascular care. Higher physician patient volumes correlate with increased cholesterol testing and fewer major adverse cardiovascular events, improving preventive care outcomes.

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Area of Science:

  • Cardiology
  • Primary Care Medicine
  • Health Services Research

Background:

  • The link between primary care physician (PCP) clinical volume and cardiovascular preventive care quality remains unclear.
  • Assessing the relationship between PCP outpatient clinical volumes and cholesterol testing rates is crucial.
  • Investigating the association between PCP clinical volumes and major adverse cardiovascular event (MACE) rates in eligible patients is needed.

Purpose of the Study:

  • To examine the association between primary care physician (PCP) outpatient clinical volumes and cholesterol testing.
  • To investigate the relationship between PCP clinical volumes and major adverse cardiovascular event (MACE) rates.
  • To determine if higher PCP clinical volumes are linked to better cardiovascular preventive care.

Main Methods:

  • Retrospective cohort study using the Cardiovascular Health in Ambulatory Care Research Team (CANHEART) cohort (2008-2012).
  • Included almost all adult residents of Ontario, Canada.
  • Compared cholesterol testing and MACE rates across PCP clinical volume quintiles.

Main Results:

  • Higher PCP clinical volumes were associated with increased cholesterol testing rates.
  • A 10.5% relative increase in cholesterol testing probability for every doubling of clinical volume.
  • Patients with lower volume PCPs had higher rates of major adverse cardiovascular events (adjusted HR 1.15).

Conclusions:

  • Physicians with lower clinical volumes provided less frequent cholesterol testing.
  • Patients treated by lower volume PCPs experienced higher rates of incident cardiovascular events.
  • Further research is warranted to understand the drivers of this relationship and optimize cardiovascular preventive care.