Impact of guidelines on health care use for the management of dyslipidemia in two Canadian provinces, Alberta and Nova Scotia, from 1990 to 2001.
BACKGROUND
Guidelines for the treatment of hyperlipidemia aim at improving the management of people at a higher risk of developing cardiovascular disease.


OBJECTIVE
To study the potential impact of hyperlipidemia guidelines on health care use in two Canadian provinces with different levels of hyperlipidemia.


METHODS
Trends in physician billing were obtained from Alberta between 1990 and 2000 and from Nova Scotia between 1994 to 2001 using the 272 primary diagnostic code for hyperlipidemia. Record linkage between a 272 code and a prescription in the subsequent six months was made through the Pharmacare database (which automatically registers all individuals 65 years of age and over). Data were also linked between the 1995 Nova Scotia Health Survey and the Pharmacare data.


RESULTS
Trends in hyperlipidemia codes were similar in Alberta and Nova Scotia by sex and age, with acceleration in the final years of the study. Approximately 5% of the adult population had a diagnosis of hyperlipidemia. Less than 60% of people aged 65 years and over with a 272 code filled an antilipemic prescription in the subsequent six months. Using the National Cholesterol Education Program Adult Treatment Panel III classification and the 1995 Nova Scotia Health Survey, less than 10% of the participants aged 65 years and over had a corresponding diagnostic code of 272, while more than half could be classified as having hyperlipidemia. In 1995, approximately one-half of people at high risk, with a 272 code in the subsequent five years, had a prescription for antilipemic drugs.


CONCLUSIONS
Despite some limitations, these data show a discrepancy between guideline development and practice, leaving a high number of at-risk individuals undiagnosed and untreated. Mechanisms need to be put in place to ensure better classification and follow-up of people with hyperlipidemia at risk for cardiovascular disease.
Joffres
Michel R
MR
Department of Community Health and Epidemiology, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia. michel.joffres@dal.ca
Kamath
Tripthi V
TV
Williams
G Rhys
GR
Casey
Jill
J
Svenson
Lawrence W
LW
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000416:Alberta / Q000453:epidemiology; D016303:Clinical Pharmacy Information Systems / Q000706:statistics & numerical data; D003695:Delivery of Health Care / Q000592:standards; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D004363:Drug Utilization / Q000706:statistics & numerical data*; D005260:Female; D019983:Guideline Adherence / Q000592:standards*; D006306:Health Surveys; D006801:Humans; D006949:Hyperlipidemias / Q000188:drug therapy* / Q000453:epidemiology; D000960:Hypolipidemic Agents / Q000627:therapeutic use*; D008074:Lipoproteins / Q000097:blood; D008297:Male; D008875:Middle Aged; D009674:Nova Scotia / Q000453:epidemiology; D017410:Practice Guidelines as Topic / Q000592:standards*; D010818:Practice Patterns, Physicians'; D015995:Prevalence; D012737:Sex Factors; D016896:Treatment Outcome
D000960:Hypolipidemic Agents; D008074:Lipoproteins