| Optimizing treatment of dyslipidemia in patients with coronary artery disease in the managed-care environment (the Rocky Mountain Kaiser Permanente experience). | |
| | |
MedLine Citation:
|
PMID: 10695706 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
|
Rocky Mountain Kaiser Permanente has taken aggressive steps to ensure optimal treatment of all modifiable cardiac risk factors, especially low-density lipoprotein (LDL) cholesterol, in patients with coronary artery disease. In this article, we are presenting (1) the basic rationale for our approach, (2) the critical steps translating philosophy into practice, and (3) justification for all health plans to pursue a similar course. The continuum of physician-directed disease management systems that have evolved in our region-one administered by cardiology nurses in the perihospitalization period and the other by pharmacists in the long-term, outpatient setting-is then detailed. Although the relatively short duration that our comprehensive systems have been in place precludes any assessment of their impact on cardiac death, coronary artery disease events, or coronary artery disease procedure rates, the improvements in intermediate surrogate outcomes are promising. Virtually all surveyed patients participating in our management systems have been "very" or "extremely" satisfied with their experience. The LDL-cholesterol screening rate in the approximately 2,500 participants in the programs to date has reached 97%. Of these patients, 84% have LDL cholesterol <130 mg/dL and 48% <100 mg/dL, and only 15% of those few with LDL cholesterol >130 mg/dL (2.5% overall) are currently not receiving lipid-lowering therapy. The proportions of patients on aspirin/antiplatelet and beta-blocker therapy after myocardial infarction are 97% and 92%, respectively. The lipid-screening and treatment rates, especially, represent significant improvement from our own baseline, and compare favorably with outcomes from other practice settings. In conclusion, health maintenance organizations have tremendous incentive and the unique opportunity and ability to develop systems to better manage large numbers of individuals with coronary artery disease. |
| | |
Authors:
|
J A Merenich; T R Lousberg; S H Brennan; N B Calonge |
Related Documents
:
|
8960446 - Secondary preventive potential of lipid-lowering drugs. the bezafibrate coronary athero... 11238486 - Cardiac mass and function, carotid artery intima-media thickness, and lipoprotein level... 14975476 - Statin therapy is associated with improved survival in ischemic and non-ischemic heart ... 17383296 - Statin use was associated with reduced mortality in both ischemic and nonischemic cardi... 23571836 - Qrs morphology, left ventricular lead location, and clinical outcome in patients receiv... 11399386 - The prehospital electrocardiogram. |
Publication Detail:
|
Type: Journal Article; Review |
Journal Detail:
|
Title: The American journal of cardiology Volume: 85 ISSN: 0002-9149 ISO Abbreviation: Am. J. Cardiol. Publication Date: 2000 Feb |
Date Detail:
|
Created Date: 2000-03-13 Completed Date: 2000-03-13 Revised Date: 2006-11-15 |
Medline Journal Info:
|
Nlm Unique ID: 0207277 Medline TA: Am J Cardiol Country: UNITED STATES |
Other Details:
|
Languages: eng Pagination: 36A-42A Citation Subset: AIM; IM |
Affiliation:
|
Department of Endocrinology, Rocky Mountain Kaiser Permanente, Denver, Colorado 80205, USA. |
Export Citation:
|
APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
|
Antilipemic Agents
/
therapeutic use Cholesterol, LDL / blood* Colorado Coronary Disease / blood, complications*, therapy Health Maintenance Organizations / organization & administration* Humans Hyperlipidemias / blood, complications, drug therapy* Managed Care Programs / organization & administration* Patient Satisfaction |
| Chemical | |
Reg. No./Substance:
|
0/Antilipemic Agents; 0/Cholesterol, LDL |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
Previous Document: Strategies for implementing lipid-lowering therapy: pharmacy-based approach.
Next Document: Improving patient outcomes by pooling resources (the Texas Heart Care Partnership experience).