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Journal of General Internal Medicine

, Volume 21, Issue 1, pp 22–29 | Cite as

Randomized controlled trial of an informatics-based intervention to increase statin prescription for secondary prevention of coronary disease

  • William T. LesterEmail author
  • Richard W. Grant
  • G. Octo Barnett
  • Henry C. Chueh
Original Articles

Abstract

OBJECTIVE: Suboptimal treatment of hyperlipidemia in patients with coronary artery disease (CAD) is well documented. We report the impact of a computer-assisted physician-directed intervention to improve secondary prevention of hyperlipidemia.

DESIGN AND SETTING: Two hundred thirty-five patients under the care of 14 primary care physicians in an academically affiliated practice with an electronic health record were enrolled in this proof-of-concept physician-blinded randomized, controlled trial. Each patient with CAD or risk equivalent above National Cholesterol Education Program-recommended low-density lipoprotein (LDL) treatment goal for greater than 6 months was randomized, stratified by physician and baseline LDL. Physicians received a single e-mail per intervention patient. E-mails were visit independent, provided decision support, and facilitated “one-click” order writing.

MEASUREMENTS: The primary outcomes were changes in hyperlipidemia prescriptions, time to prescription change, and changes in LDL levels. The time spent using the system was assessed among intervention patients.

RESULTS: A greater proportion of intervention patients had prescription changes at 1 month (15.3% vs 2%, P=.001) and 1 year (24.6% vs 17.1%, P=.14). The median interval to first medication adjustment occurred earlier among intervention patients (0 vs 7.1 months, P=.005). Among patients with baseline LDLs >130 mg/dL, the first postintervention LDLs were substantially lower in the intervention group (119.0 vs 138.0 mg/dL, P=.04). Physician processing time was under 60 seconds per e-mail.

CONCLUSION: A visit-independent disease management tool resulted in significant improvement in secondary prevention of hyperlipidemia at 1-month postintervention and showed a trend toward improvement at 1 year.

Key Words

hyperlipidemia electronic health records reminder systems randomized-controlled trial 

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Copyright information

© Society of General Internal Medicine 2006

Authors and Affiliations

  • William T. Lester
    • 1
    Email author
  • Richard W. Grant
    • 2
    • 3
  • G. Octo Barnett
    • 1
  • Henry C. Chueh
    • 1
    • 3
  1. 1.Laboratory of Computer ScienceMassachusetts General Hospital, and Harvard Medical SchoolBostonUSA
  2. 2.General Medicine UnitMassachusetts General Hospital, and Harvard Medical SchoolBostonUSA
  3. 3.Clinical Research ProgramMassachusetts General Hospital, and Harvard Medical SchoolBostonUSA

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