Low-density lipoprotein cholesterol goal attainment among high-risk patients: Does a combined intervention targeting patients and providers work?
BACKGROUND
Physicians are aware of the National Cholesterol Education Program guidelines; however, most patients fail to attain cholesterol goals.


OBJECTIVE
To determine whether a combined program of patient education and provider awareness could improve the National Cholesterol Education Program goal attainment among patients at high risk for cardiovascular events.


METHODS
One hundred seven high-risk patients with cardiovascular disease were educated in a single 15-minute session regarding their cholesterol levels, risk factors, and medication adherence. Those with scores of 2 or lower on the Morisky questionnaire were classified as low-adherence patients, and those with scores of 3 or higher were classified as high-adherence patients. Seven physicians were provided this information and were requested to evaluate the dyslipidemia management of these patients. Lipid levels were reevaluated 8 to 12 weeks after the intervention.


RESULTS
At the start of the study, 38 (35.5%) of the 107 patients were at target low-density lipoprotein cholesterol (LDL-C) levels, and 64 of the 107 patients (59.8%) were at target levels after the intervention. High-adherence patients decreased their LDL-C levels from a mean of 118.6 mg/dL (3.07 mmol/L) to 98.6 mg/dL (2.55 mmol/L); low-adherence patients increased their LDL-C levels after the intervention from 134.5 mg/dL (3.48 mmol/L) to 142.1 mg/dL (3.68 mmol/L). A comparison between the LDL-C goal achievers vs nonachievers revealed a significant difference in adherence (P = .001). Among the goal achievers, significant decreases in preintervention vs postintervention total cholesterol levels (P = .001) and LDL-C levels (P = .001) were also noted.


CONCLUSIONS
This study demonstrates that an intervention simultaneously targeting patients and providers is successful in improving goal attainment among high-risk patients.
Afonso
Nelia M
NM
Department of Medicine, Wayne State University School of Medicine, 5C WSU Health Center, 4201 St Antoine Dr, Detroit, MI 48201-2153, USA. nafonso@med.wayne.edu
Nassif
George
G
Aranha
Anil N F
AN
Delor
Bonnie
B
Cardozo
Lavoisier J
LJ
D000328:Adult; D000368:Aged; D008078:Cholesterol, LDL / Q000032:analysis / Q000187:drug effects*; D015331:Cohort Studies; D050171:Dyslipidemias; D005260:Female; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic; D010821:Physicians, Family; D011446:Prospective Studies; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
D008078:Cholesterol, LDL