Stephen D Persell1, Tiffany Brown2, Ji Young Lee2, Shreya Shah2, Eric Henley2, Timothy Long2, Stephanie Luther2, Donald M Lloyd-Jones2, Muriel Jean-Jacques2, Namratha R Kandula2, Thomas Sanchez2, David W Baker2. 1. From the Division of General Internal Medicine and Geriatrics, Department of Medicine (S.D.P., T.B., J.Y.L., S.S., M.J.-J., N.R.K., D.W.B.), Center for Primary Care Innovation, Institute for Public Health and Medicine (S.D.P., N.R.K., D.W.B.), Division of Cardiology (D.M.L.-J.), and Department of Preventive Medicine (D.M.L.-J., N.R.K.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Department of Medicine, Stanford University, Stanford, CA (S.S.); North Country Healthcare, Flagstaff, AZ (E.H.); Near North Health Service Corporation, Chicago, IL (T.L., T.S.); Alliance of Chicago Community Health Services, Chicago, IL (T.L., T.S.); and Heartland Health Outreach, Chicago, IL (S.L.). spersell@nm.org. 2. From the Division of General Internal Medicine and Geriatrics, Department of Medicine (S.D.P., T.B., J.Y.L., S.S., M.J.-J., N.R.K., D.W.B.), Center for Primary Care Innovation, Institute for Public Health and Medicine (S.D.P., N.R.K., D.W.B.), Division of Cardiology (D.M.L.-J.), and Department of Preventive Medicine (D.M.L.-J., N.R.K.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Department of Medicine, Stanford University, Stanford, CA (S.S.); North Country Healthcare, Flagstaff, AZ (E.H.); Near North Health Service Corporation, Chicago, IL (T.L., T.S.); Alliance of Chicago Community Health Services, Chicago, IL (T.L., T.S.); and Heartland Health Outreach, Chicago, IL (S.L.).
Abstract
BACKGROUND: Many eligible primary cardiovascular disease prevention candidates are not treated with statins. Electronic health record data can identify patients with increased cardiovascular disease risk. METHODS AND RESULTS: We performed a pragmatic randomized controlled trial at community health centers in 2 states. Participants were men aged ≥35 years and women≥45 years, without cardiovascular disease or diabetes mellitus, and with a 10-year risk of coronary heart disease of at least 10%. The intervention group received telephone and mailed outreach, individualized based on patients' cardiovascular disease risk and uncontrolled risk factors, provided by lay health workers. Main outcomes included: documented discussion of medication treatment for cholesterol with a primary care clinician, receipt of statin prescription within 6 months, and low-density lipoprotein (LDL)-cholesterol repeated and at least 30 mg/dL lower than baseline within 1 year. Six hundred forty-six participants (328 and 318 in the intervention and control groups, respectively) were included. At 6 months, 26.8% of intervention and 11.6% of control patients had discussed cholesterol treatment with a primary care clinician (odds ratio, 2.79; [95% confidence interval, 2.25-3.46]). Statin prescribing occurred for 10.1% in the intervention group and 6.0% in the control group (odds ratio, 1.76; [95% confidence interval, 0.90-3.45]). The cholesterol outcome did not differ, and the majority of patients did not repeat lipid levels during follow-up. CONCLUSIONS: Risk communication and lay outreach increased cholesterol treatment discussions with primary care clinicians. However, most discussions did not result in statin prescribing. For outreach to be successful, it should be combined with interventions to encourage clinicians to follow contemporary risk-based cholesterol treatment guidelines. CLINICAL TRIAL REGISTRATION: URL: http://www.clincialtrials.gov. Unique identifier: NCT01610609.
RCT Entities:
BACKGROUND: Many eligible primary cardiovascular disease prevention candidates are not treated with statins. Electronic health record data can identify patients with increased cardiovascular disease risk. METHODS AND RESULTS: We performed a pragmatic randomized controlled trial at community health centers in 2 states. Participants were men aged ≥35 years and women ≥45 years, without cardiovascular disease or diabetes mellitus, and with a 10-year risk of coronary heart disease of at least 10%. The intervention group received telephone and mailed outreach, individualized based on patients' cardiovascular disease risk and uncontrolled risk factors, provided by lay health workers. Main outcomes included: documented discussion of medication treatment for cholesterol with a primary care clinician, receipt of statin prescription within 6 months, and low-density lipoprotein (LDL)-cholesterol repeated and at least 30 mg/dL lower than baseline within 1 year. Six hundred forty-six participants (328 and 318 in the intervention and control groups, respectively) were included. At 6 months, 26.8% of intervention and 11.6% of control patients had discussed cholesterol treatment with a primary care clinician (odds ratio, 2.79; [95% confidence interval, 2.25-3.46]). Statin prescribing occurred for 10.1% in the intervention group and 6.0% in the control group (odds ratio, 1.76; [95% confidence interval, 0.90-3.45]). The cholesterol outcome did not differ, and the majority of patients did not repeat lipid levels during follow-up. CONCLUSIONS: Risk communication and lay outreach increased cholesterol treatment discussions with primary care clinicians. However, most discussions did not result in statin prescribing. For outreach to be successful, it should be combined with interventions to encourage clinicians to follow contemporary risk-based cholesterol treatment guidelines. CLINICAL TRIAL REGISTRATION: URL: http://www.clincialtrials.gov. Unique identifier: NCT01610609.
Authors: Kunal N Karmali; Stephen D Persell; Pablo Perel; Donald M Lloyd-Jones; Mark A Berendsen; Mark D Huffman Journal: Cochrane Database Syst Rev Date: 2017-03-14
Authors: Laney K Jones; Samuel S Gidding; Terry L Seaton; Anne Goldberg; Christina Gregor; Amy C Sturm; Ross C Brownson; Alanna Kulchak Rahm; Marc S Williams Journal: Res Social Adm Pharm Date: 2019-06-15
Authors: Rachel Gold; Arwen Bunce; Stuart Cowburn; James V Davis; Celine Hollombe; Christine A Nelson; Jon Puro; John Muench; Christian Hill; Victoria Jaworski; MaryBeth Mercer; Colleen Howard; Nancy Perrin; Jennifer DeVoe Journal: BMC Health Serv Res Date: 2017-04-05 Impact factor: 2.655