| Impact of a multifaceted intervention on cholesterol management in primary care practices: guideline adherence for heart health randomized trial. | |
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MedLine Citation:
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PMID: 19364997 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Physician adherence to National Cholesterol Education Program clinical practice guidelines has been poor. METHODS: We recruited 68 primary care family and internal medicine practices; 66 were randomly allocated to a study arm; 5 practices withdrew, resulting in 29 receiving the Third Adult Treatment Panel (ATP III) intervention and 32 receiving an alternative intervention focused on the Seventh Report of the Joint National Committee on the Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC-7). The ATP III providers received a personal digital assistant providing the Framingham risk scores and ATP III-recommended treatment. All practices received copies of each clinical practice guideline, an introductory lecture, 1 performance feedback report, and 4 visits for intervention-specific academic detailing. Data were abstracted at 61 practices from random samples of medical records of patients treated from June 1, 2001, through May 31, 2003 (baseline), and from May 1, 2004, through April 30, 2006 (follow-up). The proportion screened with subsequent appropriate decision making (primary outcome) was calculated. Generalized estimating equations were used to compare results by arm, accounting for clustering of patients within practices. RESULTS: We examined 5057 baseline and 3821 follow-up medical records. The screening rate for lipid levels increased from 43.6% to 49.0% (ATP III practices) and from 40.1% to 50.8% (control practices) (net difference, -5.3% [P = .22]). Appropriate management of lipid levels decreased slightly (73.4% to 72.3%) in ATP III practices and more markedly (79.7% to 68.9%) in control practices. The net change in appropriate management favored the intervention (+9.7%; 95% confidence interval [CI], 2.8%-16.6% [P < .01]). Appropriate drug prescription within 4 months decreased in both arms (38.8% to 24.8% in ATP III practices and 45.3% to 24.1% in control practices; net change, +7.2% [P = .37]) Overtreatment declined from 6.6% to 3.9% in ATP III and rose from 4.2% to 6.4% in control practices (net change, -4.9% [P = .01]). CONCLUSIONS: A multifactor intervention including personal digital assistant-based decision support may improve primary care physician adherence to the ATP III guidelines. Trial Registration clinicaltrials.gov Identifier: NCT00224848. |
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Authors:
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Alain G Bertoni; Denise E Bonds; Haiying Chen; Patricia Hogan; Lenore Crago; Erica Rosenberger; Ann Hiott Barham; C Randall Clinch; David C Goff |
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Publication Detail:
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Type: Journal Article; Randomized Controlled Trial; Research Support, N.I.H., Extramural |
Journal Detail:
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Title: Archives of internal medicine Volume: 169 ISSN: 1538-3679 ISO Abbreviation: Arch. Intern. Med. Publication Date: 2009 Apr |
Date Detail:
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Created Date: 2009-04-14 Completed Date: 2009-05-05 Revised Date: 2011-05-25 |
Medline Journal Info:
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Nlm Unique ID: 0372440 Medline TA: Arch Intern Med Country: United States |
Other Details:
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Languages: eng Pagination: 678-86 Citation Subset: AIM; IM |
Affiliation:
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Division of Public Health Sciences, Department of Epidemiology and Prevention, Wake Forest University Baptist Medical Center, Medical Center Blvd, Winston-Salem, NC 27157, USA. abertoni@wfubmc.edu |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Aged Cardiovascular Diseases / prevention & control* Cholesterol / blood Delivery of Health Care Drug Utilization Family Practice / standards, trends Female Guideline Adherence* Humans Hyperlipidemias / diagnosis, drug therapy* Hypolipidemic Agents / administration & dosage* Intervention Studies Male Middle Aged Monitoring, Physiologic Physician's Practice Patterns Practice Guidelines as Topic Primary Health Care / standards*, trends Probability Sensitivity and Specificity United States |
| Grant Support | |
ID/Acronym/Agency:
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R01 HL070742-01/HL/NHLBI NIH HHS; R01 HL070742-02/HL/NHLBI NIH HHS; R01 HL070742-02S1/HL/NHLBI NIH HHS; R01 HL070742-03/HL/NHLBI NIH HHS; R01 HL070742-04/HL/NHLBI NIH HHS; R01 HL070742-05/HL/NHLBI NIH HHS; R01 HL70742/HL/NHLBI NIH HHS |
| Chemical | |
Reg. No./Substance:
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0/Hypolipidemic Agents; 57-88-5/Cholesterol |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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