Patient-Doctor Intervention Doesn't Aid Cholesterol Levels

Post-hoc analysis suggests potential benefit for practices that use the intervention frequently

WEDNESDAY, Nov. 16 (HealthDay News) -- An intervention based on patient activation and a physician decision support tool does not appear to offer any benefit in improving cholesterol management in primary care practices, according to a study published in the November/December issue of the Annals of Family Medicine.

Charles B. Eaton, M.D., from Alpert Medical School of Brown University in Providence, R.I., and colleagues examined the effectiveness of an intervention for improving adherence to National Cholesterol Education Program guidelines, in 30 primary care practices covering 4,105 patients. The percentage of patients screened for hyperlipidemia and treated to their low-density lipoprotein (LDL) and non-high-density lipoprotein (HDL) cholesterol goals was the main outcome measured.

The investigators found that screening improved in both the intervention and usual care groups after one year of intervention (89 percent screened). In both groups, 74 percent of patients were at their LDL and non-HDL cholesterol goals. The percentage of patients who were screened or achieved their LDL and non-HDL goals was not significantly different between the practice groups in intent-to-treat analysis. Using post-hoc analysis, practices that made greater use of the patient activation kiosk had a significantly higher likelihood of having patients screened (odds ratio [OR], 2.54) than those that made infrequent or no use of the kiosk. Patients of physicians who made high use of decision support tools had a higher likelihood of being at their LDL and non-HDL goals (ORs, 1.27 and 1.23, respectively), compared to patients of low-use or no-use physicians.

"A well-designed multimodal practice guideline implementation study in primary care practice showed no benefit to the intervention and found a strong secular trend of increased cholesterol screening and goal attainment," the authors write.

Two of the study authors are co-developers of the intervention tool used in this study.

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