Multidisciplinary vascular screening program modestly improves the medical treatment of vascular risk factors.
OBJECTIVE
This study investigated whether recommendations given to the treating vascular specialist and the GP by a multidisciplinary team of vascular specialists concerning the medical treatment of risk factors, based on international guidelines, led to an increased medication use in a high-risk population.


METHODS
Data were obtained from 618 patients enrolled in the SMART study, an ongoing single-center prospective cohort study of patients referred to the University Medical Center Utrecht for atherosclerotic vascular diseases. All patients underwent a vascular screening and their physicians received recommendations concerning the medical treatment of newly detected or not yet sufficiently treated vascular risk factors. After a median follow-up of 29 months, questionnaires about medication use were sent to 618 patients; 534 (86%) questionnaires were returned. Actual use of medication was compared with medical treatment recommendation given at baseline.


RESULTS
The proportion of patients on antihypertensive medication with hypertension (> or =140/90 mmHg) and not diagnosed with coronary heart disease increased from 56% to 68% (95% confidence interval (95% CI) 2 - 23). The frequency of lipid-lowering medication use increased substantially from 47% to 69% (95% CI 17 - 28). The frequency of glucose-lowering medication use increased slightly from 11% to 14% (95% CI 1 - 7). The use of folic acid increased from 2% to 14% (95% CI 9 - 15) in patients with hyperhomocysteinaemia.


CONCLUSIONS
Medical treatment recommendations, formulated by a multidisciplinary team, led to a significant increase in medication use. The increase is marginal compared with trends in medication use without this intervention in usual care.
Goessens
B M B
BM
Julius Center for Health Sciences and Primary Care, UMC Utrecht, the Netherlands.
Visseren
F L J
FL
Olijhoek
J K
JK
Eikelboom
B C
BC
van der Graaf
Y
Y
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001161:Arteriosclerosis / Q000175:diagnosis / Q000188:drug therapy*; D015331:Cohort Studies; D004363:Drug Utilization / Q000706:statistics & numerical data; D005260:Female; D005492:Folic Acid / Q000627:therapeutic use*; D005500:Follow-Up Studies; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D000960:Hypolipidemic Agents / Q000627:therapeutic use*; D033183:Interdisciplinary Communication; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D017063:Outcome Assessment, Health Care; D010348:Patient Care Team; D011446:Prospective Studies; D012307:Risk Factors; D011795:Surveys and Questionnaires
D000959:Antihypertensive Agents; D007004:Hypoglycemic Agents; D000960:Hypolipidemic Agents; D005492:Folic Acid