title: Overcoming inertia: improvement in achieving target low-density lipoprotein cholesterol.
abstract: OBJECTIVE
  To improve lipid management of high-risk patients in a large academic primary care practice.
  
  
  METHODS
  Educational intervention with historical controls.
  
  
  METHODS
  We determined the likelihood of providers within an academic Veterans Affairs primary care practice to adjust simvastatin doses before and after a low-cost educational intervention. Study patients were enrolled during a 2-year preintervention period, had an indication to achieve a low-density lipoprotein cholesterol (LDL-C) level of <100 mg/dL, and were taking simvastatin but not at the maximum dose. We explored factors that might affect dose changing, including patient demographics, diabetes, coronary disease, patient medication adherence, and a threshold effect where LDL-C values just above the target might lead to provider inaction.
  
  
  RESULTS
  Initially, 49% of 4048 patients met their LDL-C target. Before the intervention, the simvastatin dose was changed at only 16% of 2103 patient visits where the patient was not at treatment target and was on less than the maximum dose. Providers were more likely to adjust the dose for patients with high LDL-C and those who were compliant, and less likely to adjust it for older or diabetic patients. After the intervention, 62% of 1414 patients met their treatment target. Compared with the preintervention period, providers were more likely to increase the simvastatin dose for patients not yet at their target (P = .023).
  
  
  CONCLUSIONS
  Following a low-cost intervention, providers more aggressively treated high LDL-C in high-risk patients, and more patients reached their treatment target goal.
authors.affiliation: Health Services Research and Development and the Ambulatory Care Service, Durham VA Medical Center, Durham, NC 27705, USA. kenneth.goldberg@duke.edu
authors.forename: Kenneth C
authors.initials: KC
authors.lastname: Goldberg
authors.forename: Stephanie D
authors.initials: SD
authors.lastname: Melnyk
authors.forename: David L
authors.initials: DL
authors.lastname: Simel
mesh_terms: D000328:Adult; D000924:Anticholesteremic Agents / Q000191:economics / Q000627:therapeutic use; D008078:Cholesterol, LDL / Q000191:economics*; D005260:Female; D006266:Health Education / Q000706:statistics & numerical data*; D006787:Hospitals, Veterans / Q000191:economics / Q000592:standards*; D006801:Humans; D006937:Hypercholesterolemia / Q000188:drug therapy* / Q000191:economics*; D008297:Male; D008875:Middle Aged; D009657:North Carolina; D017063:Outcome Assessment, Health Care; D010044:Outpatient Clinics, Hospital / Q000592:standards*; D011320:Primary Health Care / Q000191:economics / Q000592:standards*; D015397:Program Evaluation; D019821:Simvastatin / Q000191:economics / Q000627:therapeutic use; D016896:Treatment Outcome; D014481:United States; D014493:United States Department of Veterans Affairs; D014728:Veterans