title: Lipid-lowering drugs in ischaemic heart disease: a quasi-experimental uncontrolled before-and-after study of the effectiveness of clinical practice guidelines.
abstract: BACKGROUND
  Cardiovascular diseases(CVD), specifically ischaemic heart disease(IHD), are the main causes of death in industrialized countries. Statins are not usually prescribed in the most appropriate way. To ensure the correct prescription of these drugs, it is necessary to develop, disseminate and implement clinical practice guidelines(CPGs), and subsequently evaluate them. The main objective of this study is to evaluate the effectiveness of the implementation of consensual Lipid-lowering drugs (LLD) prescription guidelines in hospital and primary care settings, to improve the control of Low-Density Lipoprotein Cholesterol (LDL-C) levels in patients with IHD in the Terres de l'Ebre region covered by the Catalonian Health Institute. Secondary objectives are to assess the improvement of the prescription profile of these LLDs, to assess cardiovascular morbimortality and the professional profile and participant centre characteristics that govern the control of LDL-C.
  
  
  METHODS
  
  
  
  METHODS
  Quasi-experimental uncontrolled before and after study. The intervention consists of the delivery of training strategies for guideline implementation (classroom clinical sessions and on-line courses) aimed at primary care and hospital physicians. The improvement in the control of LDL-C levels in the 3,402 patients with IHD in our territory is then assessed.
  
  
  METHODS
  Primary care physicians from 11 basic health areas(BHAs) and two hospital services (internal medicine and cardiology).
  
  
  METHODS
  3,402 patients registered with IHD in the database of the Catalan Institute of Health(E-cap) before December 2008 and patients newly diagnosed during 2009-2010.
  
  
  METHODS
  Percentage of patients achieving good control of LDL-C, measured in milligrams per decilitre. The aim of the intervention is to achieve levels of LDL-C < 100 mg/dl in patients with IHD. Secondary variables measure type and time of diagnosis of IHD, type and dose of prescribed cholesterol-lowering drugs, level of physician participation in training activities and their professional profile.
  
  
  CONCLUSIONS
  The development of prescription guidelines previously agreed by various medical specialists involved in treating IHD patients have usually improved drug prescription. The guideline presented in this study aims to improve the control of LDL-C by training physicians through presential and on-line courses on the dissemination of this guideline, and by providing feedback on their personal results a year after this training intervention.
authors.affiliation: ABS Tortosa-Est, Institut Català de la Salut (ICS), Institut Universitari d'Investigació en Atenció Primària (IDIAP) Jordi Gol, Tortosa, Spain.
authors.forename: Rosa
authors.initials: R
authors.lastname: Dalmau
authors.forename: Miriam
authors.initials: M
authors.lastname: Boira
authors.forename: Carina
authors.initials: C
authors.lastname: Aguilar
authors.forename: Carlos
authors.initials: C
authors.lastname: López
authors.forename: Dolors
authors.initials: D
authors.lastname: Rodríguez
authors.forename: Delicia
authors.initials: D
authors.lastname: Gentille
authors.forename: Domingo
authors.initials: D
authors.lastname: Bofill
authors.forename: Eduard
authors.initials: E
authors.lastname: Diogene
authors.forename: Josep M
authors.initials: JM
authors.lastname: Pepió
mesh_terms: D016208:Databases, Factual; D006801:Humans; D006949:Hyperlipidemias / Q000097:blood / Q000188:drug therapy; D000960:Hypolipidemic Agents / Q000627:therapeutic use*; D008077:Lipoproteins, LDL / Q000097:blood; D015337:Multicenter Studies as Topic / Q000379:methods / Q000592:standards; D017202:Myocardial Ischemia / Q000097:blood / Q000188:drug therapy*; D058007:Physicians, Primary Care / Q000193:education / Q000592:standards*; D010919:Placebos; D017410:Practice Guidelines as Topic / Q000592:standards*; D011320:Primary Health Care / Q000592:standards*; D016896:Treatment Outcome
chemical_list: D000960:Hypolipidemic Agents; D008077:Lipoproteins, LDL; D010919:Placebos