title: Sex differences in patient and provider response to elevated low-density lipoprotein cholesterol.
abstract: BACKGROUND
  Despite American Heart Association recommendations of diet/lifestyle modification and statin therapy to achieve low-density lipoprotein cholesterol (LDL) control, women are less likely than men to be screened and achieve treatment goals. This study determined whether the provider and patient response to electronic medical record (EMR) notification of an elevated LDL varied by patient sex in veterans.
  
  
  METHODS
  Provider responses to EMR clinical reminders for an elevated LDL (≥100 mg/dL) were assessed in men (n = 40,738) and women (n = 1,025) veterans with ischemic heart disease or diabetes between October 2008 and September 2009. Responses were classified into four types: 1) Whether the patient refused medication, 2) the provider ordered or adjusted medication, 3) treatment was deferred/medications were not changed, or 4) medications were contraindicated. Logistic regression with generalized estimating equations was used to compare clinical reminder responses between men and women patients.
  
  
  RESULTS
  Providers were less likely to order or adjust medications for women (adjusted odds ratio [OR], 0.75; 95% CI, 0.63, 0.88) and women were more likely than men to refuse medication (adjusted OR, 1.71; 95% CI, 1.34, 2.17). These associations were not modified by degree of LDL elevation or use of lipid-lowering medications.
  
  
  CONCLUSIONS
  These results indicate that poorer cholesterol control in at risk women is likely a consequence of both provider and patient factors.
authors.affiliation: VA Connecticut Healthcare System, West Haven, Connecticut; Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut. Electronic address: Sally.Haskell@VA.gov.
authors.forename: Sally G
authors.initials: SG
authors.lastname: Haskell
authors.affiliation: VA Connecticut Healthcare System, West Haven, Connecticut.
authors.forename: Harini
authors.initials: H
authors.lastname: Bathulapalli
authors.affiliation: VA Connecticut Healthcare System, West Haven, Connecticut.
authors.forename: Tan
authors.initials: T
authors.lastname: Pham
authors.affiliation: VA Connecticut Healthcare System, West Haven, Connecticut; Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut.
authors.forename: Joseph
authors.initials: J
authors.lastname: Goulet
authors.affiliation: VA Connecticut Healthcare System, West Haven, Connecticut.
authors.forename: Melissa
authors.initials: M
authors.lastname: Skanderson
authors.affiliation: VA Connecticut Healthcare System, West Haven, Connecticut.
authors.forename: Mary
authors.initials: M
authors.lastname: Driscoll
authors.affiliation: VA Connecticut Healthcare System, West Haven, Connecticut; Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut; Yale Center for Medical Informatics, New Haven, Connecticut.
authors.forename: Cynthia
authors.initials: C
authors.lastname: Brandt
authors.affiliation: Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut; Yale Center for Analytical Sciences, New Haven, Connecticut.
authors.forename: James
authors.initials: J
authors.lastname: Dziura
mesh_terms: D000328:Adult; D000368:Aged; D000924:Anticholesteremic Agents / Q000627:therapeutic use*; D001291:Attitude of Health Personnel; D001294:Attitude to Health; D050171:Dyslipidemias / Q000188:drug therapy* / Q000503:physiopathology; D057286:Electronic Health Records; D005260:Female; D054625:Healthcare Disparities; D006801:Humans; D008077:Lipoproteins, LDL / Q000097:blood* / Q000187:drug effects; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010818:Practice Patterns, Physicians'; D012307:Risk Factors; D012737:Sex Factors; D016896:Treatment Outcome; D014481:United States
chemical_list: D000924:Anticholesteremic Agents; D008077:Lipoproteins, LDL