Document Detail


Electronic health record-based patient identification and individualized mailed outreach for primary cardiovascular disease prevention: a cluster randomized trial.
MedLine Citation:
PMID:  23143672     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Many individuals at higher risk for cardiovascular disease (CVD) do not receive recommended treatments. Prior interventions using personalized risk information to promote prevention did not test clinic-wide effectiveness.
OBJECTIVE AND DESIGN: To perform a 9-month cluster-randomized trial, comparing a strategy of electronic health record-based identification of patients with increased CVD risk and individualized mailed outreach to usual care.
PARTICIPANTS: Patients of participating physicians with a Framingham Risk Score of at least 5 %, low-density lipoprotein (LDL)-cholesterol level above guideline threshold for drug treatment, and not prescribed a lipid-lowering medication were included in the intention-to-treat analysis.
INTERVENTION: Patients of physicians randomized to the intervention group were mailed individualized CVD risk messages that described benefits of using a statin (and controlling hypertension or quitting smoking when relevant).
MAIN MEASURES: The primary outcome was occurrence of a LDL-cholesterol level, repeated in routine practice, that was at least 30 mg/dl lower than prior. A secondary outcome was lipid-lowering drug prescribing. Clinicaltrials.gov identifier: NCT01286311.
KEY RESULTS: Fourteen physicians with 218 patients were randomized to intervention, and 15 physicians with 217 patients to control. The mean patient age was 60.7 years and 77% were male. There was no difference in the primary outcome (11.0 % vs. 11.1 %, OR 0.99, 95 % CI 0.56-1.74, P = 0.96), but intervention group patients were twice as likely to receive a prescription for lipid-lowering medication (11.9 %, vs. 6.0 %, OR 2.13, 95 % CI 1.05-4.32, p = 0.038). In post hoc analysis with extended follow-up to 18 months, the primary outcome occurred more often in the intervention group (22.5 % vs. 16.1 %, OR 1.59, 95 % CI 1.05-2.41, P = 0.029).
CONCLUSIONS: In this effectiveness trial, individualized mailed CVD risk messages increased the frequency of new lipid-lowering drug prescriptions, but we observed no difference in proportions lowering LDL-cholesterol after 9 months. With longer follow-up, the intervention's effect on LDL-cholesterol levels was apparent.
Authors:
Stephen D Persell; Donald M Lloyd-Jones; Elisha M Friesema; Andrew J Cooper; David W Baker
Publication Detail:
Type:  Journal Article; Randomized Controlled Trial; Research Support, U.S. Gov't, P.H.S.     Date:  2012-11-11
Journal Detail:
Title:  Journal of general internal medicine     Volume:  28     ISSN:  1525-1497     ISO Abbreviation:  J Gen Intern Med     Publication Date:  2013 Apr 
Date Detail:
Created Date:  2013-03-18     Completed Date:  2013-09-26     Revised Date:  2014-04-01    
Medline Journal Info:
Nlm Unique ID:  8605834     Medline TA:  J Gen Intern Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  554-60     Citation Subset:  IM    
Data Bank Information
Bank Name/Acc. No.:
ClinicalTrials.gov/NCT01286311
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MeSH Terms
Descriptor/Qualifier:
Aged
Antihypertensive Agents / therapeutic use
Cardiovascular Diseases / prevention & control*
Cholesterol, LDL / blood
Cluster Analysis
Drug Prescriptions / statistics & numerical data
Drug Utilization / statistics & numerical data
Electronic Health Records*
Female
Health Promotion / methods,  organization & administration*
Humans
Hydroxymethylglutaryl-CoA Reductase Inhibitors / therapeutic use
Hypertension / drug therapy
Illinois
Individualized Medicine / methods
Male
Middle Aged
Postal Service
Primary Health Care / methods,  organization & administration*
Chemical
Reg. No./Substance:
0/Antihypertensive Agents; 0/Cholesterol, LDL; 0/Hydroxymethylglutaryl-CoA Reductase Inhibitors
Comments/Corrections
Comment In:
J Gen Intern Med. 2013 Apr;28(4):569   [PMID:  23307412 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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