The SaM (Screening and Monitoring) approach to cardiovascular risk-reduction in primary care--cyclic monitoring and individual treatment of patients at cardiovascular risk using the electronic medical record.
BACKGROUND
Cardiovascular disease (CVD) prevention suffers from a major gap between clinical evidence (information) and clinical practice (implementation). Insufficient control risk factor levels and under-utilization of aspirin, statins, angiotensin-converting enzyme (ACE) inhibitors and beta-blockers are well-known examples.


METHODS
The SaM (Screening and Monitoring) approach was devised by a family physician in order to facilitate closure of this gap. It does so by providing solutions to problems in the fields of information and implementation. A simple manipulation of the electronic medical record used in the practice serves to facilitate cyclic monitoring of patients with cardiovascular risk factors. Technological and human resources available in the primary care setting are used. The approach is described in the first part of the article. The second part presents results obtained by employing the approach on one family physician's patient population.


RESULTS
The final results demonstrate a marked improvement over time in risk factor levels and use of medications in accordance with indications. The values achieved are superior to those reported in the literature. Blood pressure in hypertensive patients 134/75 mmHg; haemoglobin A1c 7.27%; low-density lipoprotein-cholesterol in patients with CVD or diabetes, 97 mg/dl; patients with CVD receiving anti-thrombotic medication, 94%; dyslipidaemic patients with CVD or diabetes receiving lipid-lowering drugs, 90%; post myocardial infarction patients receiving beta-blockers, 76%; hypertensive diabetics or patients with chronic heart failure (CHF) receiving ACE-inhibitors/angiotensin receptor blockers, 86%.


CONCLUSIONS
In this one-practice pilot-study, the SaM approach was employed with marked improvement in risk factor levels and use of appropriate medications. This may translate into reductions in morbidity and mortality in a larger population.
Rabinowitz
Israel
I
Clalit Heath Services and the Department of Family Medicine, Haifa, Israel. Raly@netvision.net.il
Tamir
Ada
A
D000328:Adult; D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000209:etiology* / Q000517:prevention & control*; D003625:Data Collection; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D006937:Hypercholesterolemia / Q000150:complications / Q000188:drug therapy; D006973:Hypertension / Q000150:complications / Q000188:drug therapy; D008297:Male; D008403:Mass Screening; D016347:Medical Records Systems, Computerized; D008875:Middle Aged; D008991:Monitoring, Physiologic; D010821:Physicians, Family; D017410:Practice Guidelines as Topic; D011320:Primary Health Care; D012307:Risk Factors
D000806:Angiotensin-Converting Enzyme Inhibitors; D000894:Anti-Inflammatory Agents, Non-Steroidal