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Plebani M. Adherence to recommendations and clinical practice guidelines: not an easy task. Clin Chem Lab Med 2023; 61:2065-2066. [PMID: 37665170 DOI: 10.1515/cclm-2023-0920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Affiliation(s)
- Mario Plebani
- University of Padova, Padova, Italy
- Department of Pathology, University of Texas, TX, Galveston, USA
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Bimpas NG, Auyeung V, Tentolouris A, Tzeravini E, Eleftheriadou I, Tentolouris N. Adoption of and adherence to the Hellenic Diabetes Association guidelines for the management of subjects with type 2 diabetes mellitus by Greek physicians. Hormones (Athens) 2021; 20:347-358. [PMID: 33123974 DOI: 10.1007/s42000-020-00253-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 10/16/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE The aim of this study was to evaluate the level of adoption of and adherence to the Hellenic Diabetes Association (HDA) guidelines for the management of individuals with type 2 diabetes mellitus (T2DM) by Greek physicians. METHODS We used a constructed questionnaire distributed to physicians in Greece. The questionnaire assessed the adoption of and adherence to the general and treatment guidelines of the HDA, as well as factors affecting physicians' prescribing habits and demographic characteristics of the participating healthcare professionals. Factors affecting the preferred therapy or glycated hemoglobin target setting were evaluated using non-parametric tests. The likelihood of adherence was estimated by logistic regression models. RESULTS Adoption of the HDA guidelines was reported by 92.2% of physicians. Adherence to the treatment algorithm was reported by 53.5% and to the general HDA guidelines by 42.0% of healthcare professionals; overall adherence to both general and treatment guidelines was 26.1%. Multivariate analysis demonstrated that the likelihood of adherence to treatment guidelines was higher among individuals attending over five in comparison with those attending under two diabetes seminars per year (p = 0.037); in contrast, years of work (professional experience ≥ 21 vs. ≤ 5 years) affected adherence negatively (p = 0.031). No significant association was found between other parameters and adherence to either general or overall guidelines. CONCLUSIONS Adoption rates of the guidelines for the management of T2DM were high, while adherence rates to general and treatment guidelines were low. The rate of seminar attendance affected treatment adherence positively, while long professional practice affected treatment adherence negatively.
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Affiliation(s)
| | - Vivian Auyeung
- Kings College London, Institute of Pharmaceutical Science, London, UK
| | - Anastasios Tentolouris
- First Department of Propaedeutic Internal Medicine and Diabetes Center, Medical School, Laiko General Hospital, National and Kapodistrian University of Athens, 17 Agiou Thoma St, 115 27, Athens, Greece
| | - Evangelia Tzeravini
- First Department of Propaedeutic Internal Medicine and Diabetes Center, Medical School, Laiko General Hospital, National and Kapodistrian University of Athens, 17 Agiou Thoma St, 115 27, Athens, Greece
| | - Ioanna Eleftheriadou
- First Department of Propaedeutic Internal Medicine and Diabetes Center, Medical School, Laiko General Hospital, National and Kapodistrian University of Athens, 17 Agiou Thoma St, 115 27, Athens, Greece
| | - Nikolaos Tentolouris
- First Department of Propaedeutic Internal Medicine and Diabetes Center, Medical School, Laiko General Hospital, National and Kapodistrian University of Athens, 17 Agiou Thoma St, 115 27, Athens, Greece.
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Baha A, Kokturk N. Physician's attitude against COPD guidelines and the choice of first-line treatment for COPD. Respir Med 2020; 176:106273. [PMID: 33271467 DOI: 10.1016/j.rmed.2020.106273] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Revised: 10/30/2020] [Accepted: 11/26/2020] [Indexed: 10/22/2022]
Abstract
AIM Our aim was to evaluate changes in attitudes of pulmonologists in Turkey towards COPD guidelines and their choice of first-line treatments for COPD patients. MATERIAL-METHOD 333 physicians who completed the questionnaire were included in this cross-sectional questionnaire study. The questionnaire contained demographic data, professional information, extent of guideline use, rationales behind using or not using a guideline. The data was compared with the same survey conducted previously in 2011 and was analyzed by appropriate statistical methods. RESULTS 80 physicians were resident pulmonologists (24%), 250 physicians were specialists (75.1%). 298 (89.5%) physicians reported that they follow at least one guideline for selection of the appropriate treatment in COPD. The current application of guidelines when compared with the first survey in 2011, was found to be decreased, 91.2% and 89.5%, respectively (p = 0.07). 46.8% (n = 156) of participants thought that guidelines provided the physicians more legal protection (p < 0.001). The number of physicians who didn't follow the guidelines due to workload increased over this period of time (36.8% in 2011, 85.3% in 2018, p < 0.001). The number of physicians using inhaler steroid combinations as their first choice of treatment was found to be similar with the previous survey (p = 0.909). CONCLUSION According to the results of previous questionnaire, the application of COPD guidelines has decreased. The number of pulmonologists who declared they have no time for following or applying guidelines has profoundly increased since 2011. Despite the warnings of these guidelines, the use of inhaler steroid combination as a first treatment option in COPD is still common.
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Affiliation(s)
- Ayse Baha
- Near East University Faculty of Medicine, Department of Pulmonary Medicine, Mersin-10, Turkey.
| | - Nurdan Kokturk
- Gazi University Faculty of Medicine, Department of Pulmonary Medicine, Ankara, Turkey
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Kara E, Tecen Yucel K, Bayraktar-Ekincioglu A, Demirkan K, Tokgozoglu L, Unal S. Evaluation of internal medicine physicians' attitudes toward the treatment of dyslipidemia. Postgrad Med 2020; 132:538-543. [PMID: 32345082 DOI: 10.1080/00325481.2020.1758489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Objectives: Dyslipidemia is one of the risk factors for atherosclerotic cardiovascular disease. Cardiovascular events decrease with decreasing LDL-C levels and all guidelines emphasize the importance of LDL-C lowering. However, implementation in real life is suboptimal. This study aimed to evaluate the treatment approaches to the dyslipidemia of physicians. Methods: This study was conducted as an online survey for internal medicine specialists and residents. The survey included questions on the physicians' demographics, their attitudes toward dyslipidemia management in three different case scenarios and questions. The physicians were asked to indicate their treatment and guideline preferences in the three cases. Results: Among the 366 participants 67.5% were internal medicine specialists and 18.9% were internal medicine residents. Fourteen percent of physicians did not use guidelines in clinical practice. Five percent of specialists and 10.1% of residents doubted the necessity of dyslipidemia treatment, 30% of both specialists and residents were affected by the patient's reluctance. The specialists were more likely to state that reaching the target LDL-C should be a priority compared to the residents (p = 0.003). Most physicians (58.7%) treated the patients according to the guideline recommendations if the patients were at high risk. They were less likely to get to guideline recommendation goals if the patients were at low risk (29.8%). Conclusion: Despite overwhelming evidence, some physicians did not use guidelines and some physicians doubted the necessity of dyslipidemia treatment. A significant proportion of physicians were affected by the patient's reluctance. There is a clear need to educate physicians about the importance of guidelines.
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Affiliation(s)
- Emre Kara
- Faculty of Pharmacy, Department of Clinical Pharmacy, Hacettepe University , Ankara, Turkey
| | - Kamer Tecen Yucel
- Faculty of Pharmacy, Department of Clinical Pharmacy, Hacettepe University , Ankara, Turkey
| | | | - Kutay Demirkan
- Faculty of Pharmacy, Department of Clinical Pharmacy, Hacettepe University , Ankara, Turkey
| | - Lale Tokgozoglu
- Faculty of Medicine, Department of Cardiology, Hacettepe University , Ankara, Turkey
| | - Serhat Unal
- Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Hacettepe University , Ankara, Turkey
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Abstract
OBJECTIVES The aim of this study was to evaluate the effectiveness of clinical pathway implementation and quality improvement (QI) interventions to increase the percentage of infants with extremity fractures undergoing evaluation for suspected physical abuse, including skeletal survey (SS), and consultation with social work, and/or Child Protection Team. METHODS Charts were retrospectively reviewed to establish percentage of infants less than 12 months old with extremity fractures undergoing an SS and consultation during the prepathway (January 1, 2012 to December 31, 2013) and postpathway (January 1, 2014 to June 30, 2015) periods. Using an Ishikawa framework, key process drivers were identified and additional QI interventions (clinical decision support and provider education) were developed and implemented. Impact of QI interventions on study metrics during active QI (July 1, 2015 to June 30, 2016) and post-QI periods (July 1, 2016 to December 31, 2016) was monitored using statistical process control charts. Logistic regression assessed predictors of obtaining an SS, consultation use, and occult fracture detection. RESULTS Skeletal survey use pre- and postpathway averaged 40%, surpassing 60% on average during active QI and post-QI periods. Consultation performance averaged 46% pre- and postpathway, increasing to nearly 67% during active QI; consultation performance decreased during post-QI to 60%. A lack of trauma history and presence of femur or humerus fracture were associated with increased SS use and consultation (both P < 0.001). Overall 20% of SS revealed occult fractures.
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Rash JA, Buckley N, Busse JW, Campbell TS, Corace K, Cooper L, Flusk D, Iorio A, Lavoie KL, Poulin PA, Skidmore B. Healthcare provider knowledge, attitudes, beliefs, and practices surrounding the prescription of opioids for chronic non-cancer pain in North America: protocol for a mixed-method systematic review. Syst Rev 2018; 7:189. [PMID: 30424800 PMCID: PMC6234680 DOI: 10.1186/s13643-018-0858-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 10/29/2018] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Evidence from diverse areas of medicine (e.g., cardiovascular disease, diabetes) indicates that healthcare providers (HCPs) often do not adhere to clinical practice guidelines (CPGs) despite a clear indication to implement recommendations-a phenomenon commonly termed clinical inertia. There are a variety of reasons for clinical inertia, but HCP-related factors (e.g., knowledge, motivation, agreement with guidelines) are the most salient and amenable to intervention aimed to improve adherence. CPGs have been developed to support the safe and effective prescription of opioid medication for the management of chronic non-cancer pain. The extent of physician uptake and adherence to such guidelines is not yet well understood. The purpose of this review is to synthesize the published evidence about knowledge, attitudes, beliefs, and practices that HCPs hold regarding the prescription of opioids for chronic non-cancer pain. METHODS An experienced information specialist will perform searches of CINAHL, Embase, MEDLINE, and PsycINFO bibliographic databases. The Cochrane library, PROSPERO, and the Joanna Briggs Institute will be searched for systematic reviews. Searches will be performed from inception to the present. Quantitative and qualitative study designs that report on HCP knowledge, attitudes, beliefs, or practices in North America will be eligible for inclusion. Studies reporting on interventions to improve HCP adherence to opioid prescribing CPGs will also be eligible for inclusion. Two trained graduate-level research assistants will independently screen articles for inclusion, perform data extraction, and perform risk of bias and quality assessment using recommended tools. Confidence in qualitative evidence will be evaluated using the Grades of Recommendation, Assessment, Development, and Evaluation-Confidence in the Evidence from Qualitative Reviews (GRADE-CERQual) approach. Confidence in quantitative evidence will be assessed using the GRADE approach. DISCUSSION The ultimate goal of this work is to support interventions aiming to optimize opioid prescribing practices in order to prevent opioid-related morbidity and mortality without restricting a HCP's ability to select the most appropriate treatment for an individual patient. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42018091640 .
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Affiliation(s)
- Joshua A. Rash
- Department of Psychology, Memorial University of Newfoundland, 230 Elizabeth Ave, St. John’s, NL A1B 3X9 Canada
| | - Norman Buckley
- Department of Anesthesia, McMaster University, Hamilton, ON Canada
| | - Jason W. Busse
- Department of Anesthesia, McMaster University, Hamilton, ON Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON Canada
- The Michael G. DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, ON Canada
- The Michael G. DeGroote Centre for Medicinal Cannabis Research, McMaster University, Hamilton, ON Canada
| | | | - Kim Corace
- The Royal Ottawa Mental Health Centre, Ottawa, ON Canada
- Department of Psychiatry, University of Ottawa, Ottawa, ON Canada
- University of Ottawa Institute of Mental Health Research, Ottawa, ON Canada
| | - Lynn Cooper
- Canadian Injured Workers Alliance, Thunder Bay, ON Canada
| | - David Flusk
- Department of Anesthesia, Memorial University of Newfoundland, St. John’s, NL Canada
| | - Alfonso Iorio
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON Canada
| | - Kim L. Lavoie
- Department of Psychology, University of Quebec at Montreal, Montreal, QC Canada
- Montreal Behavioral Medicine Centre (MBMC), Centre intégrée universitaire de santé et services sociaux de Nord de l’Ile de Montreal (CIUSSS-NIM), Hopital du Sacre-Coeur de Montreal, Montreal, QC Canada
| | - Patricia A. Poulin
- The Ottawa Hospital Research Institute, Ottawa, ON Canada
- The Ottawa Hospital Pain Clinic, Ottawa, ON Canada
- School of Psychology and Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, ON Canada
| | - B. Skidmore
- Independent Information Specialist, Ottawa, ON Canada
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Ding R, Ye P, Zhao S, Zhao D, Yan X, Dong Y, Li J, Ran Y, Hu D. Effect of physician characteristics and knowledge on the quality of dyslipidemia management and LDL-C target goal achievement in China: Subgroup analysis of the Dyslipidemia International Study. J Glob Health 2018; 7:020702. [PMID: 29057073 PMCID: PMC5644362 DOI: 10.7189/jogh.07.020702] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Objective This study aimed to investigate the effect of physicians’ characteristics and knowledge of LDL–C target goals on the quality of lipid management in China. Methods A total of 25 317 dyslipidemia patients who had taken lipid–lowering medication for >3 months were enrolled in our study. Patients’ demographic data, medical history, lipid profile, their physician’s specialty and professional title and their hospital level as well as their LDL–C goal opinions were recorded. Results Questionnaires were completed by 926 physicians with 6 different specialties and 4 professional statuses, in 3 different–level hospitals. Most (74.5%) of the physicians recognized the importance of considering LDL–C serum concentration for treating dyslipidemia, and set target LDL–C goals according to the 2007 Chinese guidelines for 83.4% of their patients. The LDL–C goal achievement rate was significantly higher for patients whose physicians’ knowledge of LDL–C target goals was consistent with guideline recommendations, compared with those whose physicians’ knowledge was inconsistent with the guidelines (60.4% vs 31.1%, P < 0.0001). Physicians working in tier 1 (odds ration (OR) = 2.95; 95% CI 2.37–3.67), (OR = 1.56; 95% CI 1.34–1.81) and tier 2 (OR = 2.53; 95% CI 2.22–2.88), (OR = 1.16; 95% CI 1.06–1.27) hospitals, specialized in neurology (OR = 1.13; 95% CI 0.93–1.36), (OR = 1.57; 95% CI 1.40–1.77), internal medicine (OR = 1.07; 95% CI 0.90–1.27), (OR = 1.58; 95% CI 1.39–1.80), endocrinology (OR = 1.02; 95% CI 0.87–1.21), (OR = 1.63; 95% CI 1.47–1.82) and being a resident vs attending physician (OR = 1.05; 95% CI 0.92–1.20), (OR = 1.00; 95% CI 1.00–1.19) were independent risk factors for low knowledge of LDL–C target goals and low LDL–C goal achievement. Conclusion Chinese physicians’ characteristics and knowledge of LDL–C target goals were associated with patients’ LDL–C goal achievement.
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Affiliation(s)
- Rongjing Ding
- Department of Cardiology, Peking University People's Hospital, Beijing, China
| | - Ping Ye
- Department of Gerontology, Chinese PLA General Hospital, Medical School of Chinese PLA, Beijing, China
| | - Shuiping Zhao
- Department of Cardiology, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Dong Zhao
- Institute of Epidemiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Xiaowei Yan
- Department of Cardiology, Peking Union Medical College Hospital, Beijing, China
| | - Yugang Dong
- Department of Cardiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jihu Li
- Outcome Research, Merck Sharp & Dohme (China) Holding Ltd., Shanghai, China
| | - Yuqin Ran
- Medical Affairs, Merck Sharp & Dohme (China) Holding Ltd., Shanghai, China
| | - Dayi Hu
- Department of Cardiology, Peking University People's Hospital, Beijing, China
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Barth JH, Misra S, Aakre KM, Langlois MR, Watine J, Twomey PJ, Oosterhuis WP. Why are clinical practice guidelines not followed? Clin Chem Lab Med 2017; 54:1133-9. [PMID: 26650076 DOI: 10.1515/cclm-2015-0871] [Citation(s) in RCA: 89] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Accepted: 10/19/2015] [Indexed: 11/15/2022]
Abstract
Clinical practice guidelines (CPG) are written with the aim of collating the most up to date information into a single document that will aid clinicians in providing the best practice for their patients. There is evidence to suggest that those clinicians who adhere to CPG deliver better outcomes for their patients. Why, therefore, are clinicians so poor at adhering to CPG? The main barriers include awareness, familiarity and agreement with the contents. Secondly, clinicians must feel that they have the skills and are therefore able to deliver on the CPG. Clinicians also need to be able to overcome the inertia of "normal practice" and understand the need for change. Thirdly, the goals of clinicians and patients are not always the same as each other (or the guidelines). Finally, there are a multitude of external barriers including equipment, space, educational materials, time, staff, and financial resource. In view of the considerable energy that has been placed on guidelines, there has been extensive research into their uptake. Laboratory medicine specialists are not immune from these barriers. Most CPG that include laboratory tests do not have sufficient detail for laboratories to provide any added value. However, where appropriate recommendations are made, then it appears that laboratory specialist express the same difficulties in compliance as front-line clinicians.
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Lavoie KL, Rash JA, Campbell TS. Changing Provider Behavior in the Context of Chronic Disease Management: Focus on Clinical Inertia. Annu Rev Pharmacol Toxicol 2016; 57:263-283. [PMID: 27618738 DOI: 10.1146/annurev-pharmtox-010716-104952] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Widespread acceptance of evidence-based medicine has led to the proliferation of clinical practice guidelines as the primary mode of communicating current best practices across a range of chronic diseases. Despite overwhelming evidence supporting the benefits of their use, there is a long history of poor uptake by providers. Nonadherence to clinical practice guidelines is referred to as clinical inertia and represents provider failure to initiate or intensify treatment despite a clear indication to do so. Here we review evidence for the ubiquity of clinical inertia across a variety of chronic health conditions, as well as the organizational and system, patient, and provider factors that serve to maintain it. Limitations are highlighted in the emerging literature examining interventions to reduce clinical inertia. An evidence-based framework to address these limitations is proposed that uses behavior change theory and advocates for shared decision making and enhanced guideline development and dissemination.
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Affiliation(s)
- Kim L Lavoie
- Department of Psychology, University of Quebec at Montreal (UQAM), Montreal, Quebec H3C 3P8, Canada.,Montreal Behavioural Medicine Centre (MBMC), Research Centre, Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec H2J 1C5, Canada
| | - Joshua A Rash
- Department of Psychology, University of Calgary, Calgary, Alberta T2N 1N4, Canada;
| | - Tavis S Campbell
- Department of Psychology, University of Calgary, Calgary, Alberta T2N 1N4, Canada;
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Hallberg S, Banefelt J, Fox KM, Mesterton J, Johansson G, Levin LÅ, Sobocki P, Gandra SR. Lipid-lowering treatment patterns in patients with new cardiovascular events - estimates from population-based register data in Sweden. Int J Clin Pract 2016; 70:222-8. [PMID: 26799539 PMCID: PMC4819716 DOI: 10.1111/ijcp.12769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES The aim of this study was to assess treatment patterns of lipid-lowering therapy (LLT) in patients with hyperlipidaemia or prior cardiovascular (CV) events who experience new CV events. METHODS A retrospective population-based cohort study was conducted using Swedish medical records and registers. Patients were included in the study based on a prescription of LLT or CV event history and followed up for up to 7 years for identification of new CV events and assessment of LLT treatment patterns. Patients were stratified into three cohorts based on CV risk level. All outcomes were assessed during the year following index (the date of first new CV event). Adherence was defined as medication possession ratio (MPR) > 0.80. Persistence was defined as no gaps > 60 days in supply of drug used at index. RESULTS Of patients with major cardiovascular disease (CVD) history (n = 6881), 49% were not on LLT at index. Corresponding data for CV risk equivalent and low/unknown CV risk patients were 37% (n = 3226) and 38% (n = 2497) respectively. MPR for patients on LLT at index was similar across cohorts (0.74-0.75). The proportions of adherent (60-63%) and persistent patients (56-57%) were also similar across cohorts. Dose escalation from dose at index was seen within all cohorts and 2-3% of patients switched to a different LLT after index while 5-6% of patients augmented treatment by adding another LLT. CONCLUSIONS Almost 50% of patients with major CVD history were not on any LLT, indicating a potential therapeutic gap. Medication adherence and persistence among patients on LLT were suboptimal.
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Affiliation(s)
| | | | - K M Fox
- Strategic Healthcare Solutions, LLC, Baltimore, MD, USA
| | - J Mesterton
- Quantify Research, Stockholm, Sweden
- LIME/Medical Management Centre, Karolinska Institute, Stockholm, Sweden
| | - G Johansson
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - L-Å Levin
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - P Sobocki
- LIME/Medical Management Centre, Karolinska Institute, Stockholm, Sweden
- IMS Health, Stockholm, Sweden
| | - S R Gandra
- Amgen Inc., Thousand Oaks, CA, United States
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Barkas F, Liberopoulos EN, Kostapanos MS, Liamis G, Tziallas D, Elisaf M. Lipid target achievement among patients with very high and high cardiovascular risk in a lipid clinic. Angiology 2014; 66:346-53. [PMID: 24830420 DOI: 10.1177/0003319714535073] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This was a retrospective study that assessed achievement of lipid-lowering treatment targets in the setting of a University Hospital Lipid Clinic. Low-density lipoprotein cholesterol (LDL-C) goal attainment according to National Cholesterol Education Program-Adult Treatment Panel III (NCEP ATP III) and European Society of Cardiology/European Atherosclerosis Society (ESC/EAS) guidelines was recorded in 1000 consecutive adult patients followed for ≥3 years (mean 8 years). The LDL-C targets according to the NCEP ATP III were attained by 66% and 86% of patients with "very high" (n = 477) and "high" (n = 408) cardiovascular risk, respectively. Fewer patients were within LDL-C goals according to the ESC/EAS guidelines: 25% and 42%. Overall, 92% of the patients were on statins: 67% were on statin monotherapy, while 33% were on combinations with ezetimibe (25%), ω-3 fatty acids (5%), fibrates (4%), or colesevelam (2%). Even in a specialist lipid clinic, a large proportion of patients are not at goal according to the recent ESC/EAS guidelines.
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Affiliation(s)
- Fotios Barkas
- Department of Internal Medicine, University of Ioannina Medical School, Ioannina, Greece
| | | | - Michael S Kostapanos
- Department of Internal Medicine, University of Ioannina Medical School, Ioannina, Greece
| | - George Liamis
- Department of Internal Medicine, University of Ioannina Medical School, Ioannina, Greece
| | - Dimitrios Tziallas
- Department of Internal Medicine, University of Ioannina Medical School, Ioannina, Greece
| | - Moses Elisaf
- Department of Internal Medicine, University of Ioannina Medical School, Ioannina, Greece
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Xanthopoulou I, Davlouros P, Siahos S, Perperis A, Zaharioglou E, Alexopoulos D. First-line treatment patterns and lipid target levels attainment in very high cardiovascular risk outpatients. Lipids Health Dis 2013; 12:170. [PMID: 24209409 PMCID: PMC3833456 DOI: 10.1186/1476-511x-12-170] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2013] [Accepted: 11/05/2013] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVES Previous studies have demonstrated gaps in achievement of low-density lipoprotein-cholesterol (LDL-C) goals among patients at very high cardiovascular risk. We aimed to investigate lipid treatment patterns, rates and predictors of lipid targets attainment, in such outpatients in an urban area of Greece. METHODS This was a prospective observational study, conducted in 19 outpatient clinics of Western Greece. We recruited patients with established cardiovascular disease (CVD) and/or diabetes mellitus (DM), previously (at least 3 months before baseline assessment) untreated with any lipid lowering medication. Lipid profile assessment was performed at baseline (prior to lipid-lowering treatment initiation) and at follow-up. Lipid lowering treatment choice was at physicians' discretion and was kept constant until follow-up. RESULTS We recruited 712 patients with a mean age 61.4 ± 10.4 years, 68.0% males, 43.0% with DM, 64.7% with prior coronary artery disease-CAD. In total, 237/712 (33.3%) of prescribed regimens were of high or very high LDL-C lowering efficacy and out of them 113/237 (47.7%) comprised a combination of statin and ezetimibe. At follow-up the primary target of LDL-C < 70 mg/dL (1.8 mmol/L) was achieved in 71(10.0%) patients. The secondary target of non-HDL-C < 100 mg/dL (2.6 mmol/L) in the subgroup of patients with DM or increased triglycerides levels (>150 mg/dl or 1.7 mmol/L) was achieved in 45(11.6%) of patients. In multivariate logistic regression analysis (AUC = 0.71, 95% CIs 0.65-0.77, p < 0.001) male gender, smoking, baseline LDL-C and very high potency LDL-C lowering regimen emerged as independent predictors of LDL-C goal attainment (OR = 1.88, 95% CIs 1.03-3.44, p = 0.04, OR = 0.57, 95% CIs 0.33-0.96, p = 0.04, OR = 0.98, 95% CIs 0.98-0.99, p < 0.001 and OR = 2.21, 95% CIs 1.15-4.24, p = 0.02 respectively). CONCLUSIONS First-line management of dyslipidemia among very-high cardiovascular risk outpatients in Western Greece is unsatisfactory, with the majority of treated individuals failing to attain the LDL-C and non-HDL-C targets. This finding points out the need for intensification of statin treatment in such patients.
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Affiliation(s)
- Ioanna Xanthopoulou
- From the Department of Cardiology, Patras University Hospital, Patras, Rion 26500, Greece
| | - Periklis Davlouros
- From the Department of Cardiology, Patras University Hospital, Patras, Rion 26500, Greece
| | - Simos Siahos
- From the Department of Cardiology, Patras University Hospital, Patras, Rion 26500, Greece
| | - Angelos Perperis
- From the Department of Cardiology, Patras University Hospital, Patras, Rion 26500, Greece
| | - Evangelia Zaharioglou
- From the Department of Cardiology, Patras University Hospital, Patras, Rion 26500, Greece
| | - Dimitrios Alexopoulos
- From the Department of Cardiology, Patras University Hospital, Patras, Rion 26500, Greece
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Schaefer JR, Gitt AK, Sonntag F, Weizel A, Jannowitz C, Karmann B, Pittrow D, Bestehorn K. Lipid management in 13,000 high risk cardiovascular patients treated under daily practice conditions: LIMA Registry. Vasc Health Risk Manag 2013; 9:71-80. [PMID: 23459022 PMCID: PMC3582482 DOI: 10.2147/vhrm.s37143] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
AIMS We aimed to document the drug management of patients at high cardiovascular risk in daily practice, with the special focus on lipid-lowering treatment. METHODS AND RESULTS In this prospective noninterventional study in 2387 outpatient centers throughout Germany, a total of 13,942 high-risk patients (mean age 65.7 years, 61.6% males) were treated with simvastatin 40 mg/day at entry as monotherapy. All patients were followed up for 12 months in terms of drug utilization, laboratory values, target attainment, and clinical events (including death, hospitalization, vascular events, and dialysis). Patients had coronary heart disease in 35.0%, diabetes mellitus in 24.4%, and the combination of coronary heart disease plus diabetes mellitus in 25.7%. In 21% of patients, a cholesterol absorption inhibitor was added to statin therapy at the entry visit, and in 23%, this was added at the follow up visit 6 months later. The target values for low-density lipoprotein-cholesterol (<2.6 mmol/L) were reached by 31.8% of patients at entry and by 50.0% at the end of this registry after 12 months. Mean blood pressure decreased (from 135.9/80.5 mmHg at baseline) by 3.1/1.9 mmHg after 12 months. In patients with documented diabetes, the targeted glycated hemoglobin (HbA1c <6.5%) was reached by 33.5% at baseline and by 40.0% after 12 months. Clinical events occurred in 11.7% of patients between baseline and month 6, and in 12.0% between months 6 and 12. CONCLUSION In patients at high risk for cardiovascular events, comprehensive management under daily practice conditions leads to improvement of lipid, glucose, and blood pressure parameters. There is a need to improve secondary prevention among high-risk patients.
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Affiliation(s)
- Juergen R Schaefer
- UKGM Klinikum Marburg, Philipps-Universität Marburg, Marburg/ Lahn, Germany
| | - Anselm K Gitt
- Stiftung Institut für Herzinfarktforschung an der Universität Heidelberg, Ludwigshafen, Germany
| | | | - Achim Weizel
- Vorsitzender der DGFF (Lipid-Liga) e.V. Planegg, Germany
| | | | | | - David Pittrow
- Institut für Klinische Pharmakologie, Dresden, Germany
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Lehto HR, Lehto S, Havulinna AS, Jousilahti P, Salomaa V. Gender differences in the prevalence, causes and treatment of high cardiovascular risk: findings from the FINRISK Survey. Eur J Prev Cardiol 2011; 19:1153-60. [DOI: 10.1177/1741826711422454] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
| | | | - Aki S Havulinna
- THL National Institute for Health and Welfare, Helsinki, Finland
| | - Pekka Jousilahti
- THL National Institute for Health and Welfare, Helsinki, Finland
| | - Veikko Salomaa
- THL National Institute for Health and Welfare, Helsinki, Finland
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