A laboratory based intervention to improve appropriateness of lipid tests and audit cholesterol lowering in primary care.
OBJECTIVE
A need exists to reduce inequalities in lipid testing, to provide relevant, individual, patient based interpretation for users, and to audit lipid lowering in primary care.


METHODS
Model to compare laboratory activity between different general practices; construction of computer based strategies to define the lipid tests to be done and to interpret results for primary and secondary coronary prevention patients; introduction of the strategies into routine use; monitoring of any change after the intervention; and investigation of the potential of the strategies to produce audit data for primary care groups.


METHODS
Hospital clinical laboratory serving 22 general practices covering 150 000 patients in Bishop Auckland area County Durham. Key measurements for improvement: Reduction in differences in testing for the different serum lipids in coronary prevention. Production of usable audit data for the primary care groups involved.


METHODS
Four different categories of coronary prevention patient, with, for each category, the defined lipid tests to be done and advice to be given (based on the results), using the computer based strategies.


RESULTS
Standardised test activity and the qualitative profile of the tests performed changed significantly. The strategies were readily adopted (median use 78%) within six months of introduction.


CONCLUSIONS
Computer based strategies can correct qualitative and quantitative differences in test requesting, provide interpretative guidance in accordance with national guidelines, and offer a cost effective model to monitor results of cholesterol lowering in general practice.
Smellie
W S
WS
Clinical Laboratory, General Hospital, Bishop Auckland, County Durham DL14 6AD. info@smellie.com
Lowrie
R
R
Wilkinson
E
E
D008076:Cholesterol, HDL / Q000097:blood; D003327:Coronary Disease / Q000517:prevention & control*; D004739:England; D005194:Family Practice / Q000592:standards; D006801:Humans; D000960:Hypolipidemic Agents / Q000627:therapeutic use*; D007755:Laboratories, Hospital / Q000592:standards; D008055:Lipids / Q000097:blood*; D008485:Medical Audit; D011320:Primary Health Care / Q000592:standards*; D011364:Professional Practice / Q000592:standards*
D008076:Cholesterol, HDL; D000960:Hypolipidemic Agents; D008055:Lipids