title: A managed care organization's use of integrated health management to improve secondary prevention of coronary artery disease.
abstract: OBJECTIVE
  To evaluate the effect of a managed care organization's multifactorial intervention program in optimizing secondary prevention of coronary artery disease (CAD).
  
  
  METHODS
  Retrospective observational analysis of claims-based data of health plan members with CAD receiving 1 or more prescriptions per year of any of the following classes of medications used for secondary prevention of CAD: lipid-lowering agents, angiotensin-converting enzyme (ACE) inhibitors, or angiotensin receptor blockers (ARBs) and beta-blockers.
  
  
  METHODS
  Claims-based data of members from 2000 to 2004 were analyzed to discover trends in the use of medications for secondary prevention of CAD. chi(2) Test of proportion was used to determine whether the changes in the annual medication use rates were statistically significant.
  
  
  RESULTS
  The annual medication use rates improved consistently throughout each year of the study period. From 2000 to 2004, the medication use rates increased for lipid-lowering agents (from 55% to 71%), ACE inhibitors or ARBs (from 44% to 55%), and beta-blockers (from 36% to 47%). Changes in all 3 indicators were statistically significant at P < .001.
  
  
  CONCLUSIONS
  An integrated multifactorial approach is essential in addressing the underutilization of therapies available for secondary prevention of CAD. Managed care organizations are in a unique position to optimize the use of evidence-based pharmacological and behavioral therapies to effectively prevent and treat the underlying pathophysiology of CAD in member populations.
authors.affiliation: Hawaii Medical Service Association, PO Box 860, Honolulu, HI 96808-0860, USA.
authors.forename: John T
authors.initials: JT
authors.lastname: Berthiaume
authors.forename: Jim
authors.initials: J
authors.lastname: Davis
authors.forename: Deborah A
authors.initials: DA
authors.lastname: Taira
authors.forename: Ko Ko
authors.initials: KK
authors.lastname: Thein
mesh_terms: D000293:Adolescent; D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D015331:Cohort Studies; D003324:Coronary Artery Disease / Q000188:drug therapy* / Q000401:mortality / Q000517:prevention & control*; D019033:Delivery of Health Care, Integrated; D019468:Disease Management; D017723:Drug Utilization Review; D019317:Evidence-Based Medicine; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D000960:Hypolipidemic Agents / Q000627:therapeutic use; D008297:Male; D008329:Managed Care Programs / Q000458:organization & administration* / Q000592:standards; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D012189:Retrospective Studies; D018570:Risk Assessment; D055502:Secondary Prevention; D016019:Survival Analysis; D014481:United States
chemical_list: D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D000960:Hypolipidemic Agents