Can the Use of Cardiology Medical Record to Deliver Educational Intervention Improve Care? On Behalf of TAPP Program: Thinking Approach Towards Physician Support in Patient Management

Langer A, Tan M, Goldin L, Langer G
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Abstract

Background: Despite clear and concise practice guidelines, strategies for lowering LDL-C are often poorly adopted in clinical practice, and many patients fail to reach guideline-recommended levels despite physician education and quality improvement programs. We studied whether physician focussed, guideline-based practice level educational intervention can improve lipid lowering management. Methods: Cardiologists or internal medicine specialists from the province of Ontario, Canada who were using a cardiology specific EMR (CEREBRUM, WELL Health Technologies Corporation) were invited to participate. Practice level data of patients with history of acute coronary syndromes (ACS) and lipid profile were studied. Physicians were alerted when patients in their practice were not treated according to recommendations. The primary endpoint was proportion of patients achieving the recommended LDL-C level of below 1.8 mmol/L. Results: Of the invited 378 specialists, 178 agreed to participate and shared their practice involving 7,683 ACS patients who were 70.4 ± 10.3 years of age and 27.2% were women. Overall, 57.7% of patients had LDL-C < 1.8 mmol/L at the start of the program (1.84 ± 0.87 mmol/L) and 63.0% (1.75 ± 0.79 mmol/L) at the end of the program (p<0.0001). With respect to the lipid lowering therapy, statin therapy was used in 52.9% of patients at the start of the program and increased to 72.1% at the end (p<0.0001). The use of ezetimibe increased from 12.6% to 19.0% (p<0.0001) and the use of PCSK9i from 1.2% to 2.4% (p<0.0001). Conclusion: The results indicate the feasibility of using EMR as a platform to deliver educational intervention and overcoming treatment inertia and improving LDL-C lowering.
使用心脏病学病历进行教育干预能否改善护理?代表 TAPP 计划:医生支持患者管理的思考方法
背景:尽管有简明扼要的实践指南,但在临床实践中,降低低密度脂蛋白胆固醇(LDL-C)的策略往往没有得到很好的采用,尽管有医生教育和质量改进计划,但许多患者还是达不到指南推荐的水平。我们研究了以医生为重点、以指南为基础的实践层面教育干预能否改善降脂管理。方法:邀请加拿大安大略省使用心脏病学专用电子病历(CEREBRUM,WELL Health Technologies Corporation)的心脏病学家或内科专家参加。研究对象是有急性冠状动脉综合征(ACS)病史和血脂情况的患者的诊疗数据。如果医生在诊疗过程中没有按照建议对患者进行治疗,医生就会收到提醒。主要终点是达到建议的低密度脂蛋白胆固醇(LDL-C)低于 1.8 mmol/L 水平的患者比例。结果:在受邀的 378 名专科医生中,有 178 名同意参与并分享了他们的治疗方法,涉及 7,683 名 ACS 患者,这些患者的年龄为 70.4 ± 10.3 岁,27.2% 为女性。总体而言,57.7%的患者在计划开始时 LDL-C < 1.8 mmol/L(1.84 ± 0.87 mmol/L),在计划结束时为 63.0%(1.75 ± 0.79 mmol/L)(P<0.0001)。在降脂治疗方面,52.9%的患者在计划开始时使用他汀类药物治疗,在计划结束时增加到72.1%(p<0.0001)。依折麦布的使用率从12.6%增至19.0%(p<0.0001),PCSK9i的使用率从1.2%增至2.4%(p<0.0001)。结论研究结果表明,以电子病历为平台提供教育干预、克服治疗惰性和改善低密度脂蛋白胆固醇降低情况是可行的。
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