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Overcoming inertia: improvement in achieving target low-density lipoprotein cholesterol.

Publication ,  Journal Article
Goldberg, KC; Melnyk, SD; Simel, DL
Published in: Am J Manag Care
September 2007

OBJECTIVE: To improve lipid management of high-risk patients in a large academic primary care practice. STUDY DESIGN: Educational intervention with historical controls. METHODS: We determined the likelihood of providers within an academic Veterans Affairs primary care practice to adjust simvastatin doses before and after a low-cost educational intervention. Study patients were enrolled during a 2-year preintervention period, had an indication to achieve a low-density lipoprotein cholesterol (LDL-C) level of <100 mg/dL, and were taking simvastatin but not at the maximum dose. We explored factors that might affect dose changing, including patient demographics, diabetes, coronary disease, patient medication adherence, and a threshold effect where LDL-C values just above the target might lead to provider inaction. RESULTS: Initially, 49% of 4048 patients met their LDL-C target. Before the intervention, the simvastatin dose was changed at only 16% of 2103 patient visits where the patient was not at treatment target and was on less than the maximum dose. Providers were more likely to adjust the dose for patients with high LDL-C and those who were compliant, and less likely to adjust it for older or diabetic patients. After the intervention, 62% of 1414 patients met their treatment target. Compared with the preintervention period, providers were more likely to increase the simvastatin dose for patients not yet at their target (P = .023). CONCLUSION: Following a low-cost intervention, providers more aggressively treated high LDL-C in high-risk patients, and more patients reached their treatment target goal.

Duke Scholars

Published In

Am J Manag Care

EISSN

1936-2692

Publication Date

September 2007

Volume

13

Issue

9

Start / End Page

530 / 534

Location

United States

Related Subject Headings

  • Veterans
  • United States Department of Veterans Affairs
  • United States
  • Treatment Outcome
  • Simvastatin
  • Program Evaluation
  • Primary Health Care
  • Outpatient Clinics, Hospital
  • Outcome Assessment, Health Care
  • North Carolina
 

Citation

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Goldberg, K. C., Melnyk, S. D., & Simel, D. L. (2007). Overcoming inertia: improvement in achieving target low-density lipoprotein cholesterol. Am J Manag Care, 13(9), 530–534.
Goldberg, Kenneth C., Stephanie D. Melnyk, and David L. Simel. “Overcoming inertia: improvement in achieving target low-density lipoprotein cholesterol.Am J Manag Care 13, no. 9 (September 2007): 530–34.
Goldberg KC, Melnyk SD, Simel DL. Overcoming inertia: improvement in achieving target low-density lipoprotein cholesterol. Am J Manag Care. 2007 Sep;13(9):530–4.
Goldberg, Kenneth C., et al. “Overcoming inertia: improvement in achieving target low-density lipoprotein cholesterol.Am J Manag Care, vol. 13, no. 9, Sept. 2007, pp. 530–34.
Goldberg KC, Melnyk SD, Simel DL. Overcoming inertia: improvement in achieving target low-density lipoprotein cholesterol. Am J Manag Care. 2007 Sep;13(9):530–534.

Published In

Am J Manag Care

EISSN

1936-2692

Publication Date

September 2007

Volume

13

Issue

9

Start / End Page

530 / 534

Location

United States

Related Subject Headings

  • Veterans
  • United States Department of Veterans Affairs
  • United States
  • Treatment Outcome
  • Simvastatin
  • Program Evaluation
  • Primary Health Care
  • Outpatient Clinics, Hospital
  • Outcome Assessment, Health Care
  • North Carolina