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


METHODS
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.


METHODS
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.


CONCLUSIONS
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.
Lester
William T
WT
Laboratory of Computer Science, Massachusetts General Hospital, and Harvard Medical School, Boston, Mass, USA. wlester@partners.org
Grant
Richard W
RW
Barnett
G Octo
GO
Chueh
Henry C
HC
D000328:Adult; D003327:Coronary Disease / Q000517:prevention & control*; D020000:Decision Support Systems, Clinical; D019468:Disease Management; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D034742:Electronic Mail; D005260:Female; D006785:Hospitals, University; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D006949:Hyperlipidemias / Q000188:drug therapy*; D008297:Male; D050316:Medical Order Entry Systems; D016347:Medical Records Systems, Computerized; D008875:Middle Aged; D010821:Physicians, Family; D017010:Reminder Systems
D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors