Barriers to Non-HDL Cholesterol Goal Attainment by Providers
Health Policy and Quality Program, Michael E. DeBakey VA Medical Center, Health Services Research and Development Center of Excellence and Section of Health Services Research, Baylor College of Medicine, Houston, TX 77030, USA. The American journal of medicine
(Impact Factor: 5).
09/2011; 124(9):876-80.e2. DOI: 10.1016/j.amjmed.2011.02.012
Despite improvements in low-density lipoprotein cholesterol goal attainment, non-high-density lipoprotein cholesterol (non-HDL-C) goal attainment remains poor. This study assessed providers' knowledge of, attitude toward, and practice regarding non-HDL-C.
Based on a conceptual model, we designed a questionnaire that was administered to internal medicine, family practice, cardiology, and endocrinology providers attending continuous medical education conferences. Responses were compared with those of providers attending a clinical lipidology conference.
The response rate was 33.3% (354/1063). Among providers attending nonlipidology conferences, only 26% knew that non-HDL-C was a secondary treatment target, 34% knew non-HDL-C treatment goals, 56% could calculate non-HDL-C levels, and 66% knew that non-HDL-C levels could be calculated from a standard lipid panel. Compared with providers attending the lipidology conference, the other providers were less likely (P≤.01) to have read the Adult Treatment Panel III guidelines (46% vs 98%) or to use non-HDL-C (36% vs 91%). No differences were found between primary care and specialty providers. Lack of familiarity with Adult Treatment Panel III guidelines (34%) and of knowledge regarding non-HDL-C importance (21%) and calculation (22.7%) were the most common barriers identified.
Major gaps remain in providers' awareness regarding non-HDL-C definition, calculation, and goals. System-level interventions are needed across specialties to address these gaps.
Available from: Peter Toth
- "c o m / i j c -m e t a b o l i c -a n d -e n d o c r i n e high triglycerides N200 mg/dL plus non-HDL-C N 130 mg/dL with low HDL-C [b40 mg/dL]) and acute coronary syndromes. More recently, there have been reports of suboptimal achievement of the combined LDL-C and non-HDL-C goal in hypertriglyceridemic and high-risk patients  . This may be partly due to lack of awareness of the non-HDL-C goal [10,12], but there may also be variability in the effectiveness of different lipid-lowering treatments on non-HDL-C. "
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ABSTRACT: Guidelines suggest that the combination of low-density lipoprotein cholesterol (LDL-C) and non-high-density lipoprotein cholesterol (non-HDL-C) is the most clinically relevant goal for lipid-lowering treatments.Methods
Data from VOYAGER, an individual patient data meta-analysis including 32,258 patients from 37 clinical trials, was used to determine the percentage of patients reaching combined goals of LDL-C and non-HDL-C following treatment with simvastatin, atorvastatin, or rosuvastatin. Paired comparisons were made between each dose of rosuvastatin and the same or higher doses of simvastatin and atorvastatin.ResultsEach dose of rosuvastatin brought significantly more patients to the combined goal of LDL-C < 100 mg/dL and non-HDL-C < 130 mg/dL than the same or double dose of atorvastatin; atorvastatin 80 mg was significantly superior to rosuvastatin 10 mg (all p < 0.001). Each dose of rosuvastatin helped significantly more patients reach the combined goal than any dose of simvastatin (all p < 0.001), except for rosuvastatin 10 mg versus simvastatin 80 mg (non-significant). Also, each dose of rosuvastatin helped significantly more patients to reach the combined goal of LDL-C < 70 mg/dL and non-HDL-C < 100 mg/dL than the same or double dose of atorvastatin (all p < 0.001). Every dose of rosuvastatin was significantly superior to all doses of simvastatin (all p ≤ 0.020), except for rosuvastatin 10 mg versus simvastatin 40 mg and 80 mg (non-significant).Conclusions
Physicians' choice of statin and dose is important in helping patients achieve the combined LDL-C and non-HDL-C goals recommended in established guidelines.
Available from: ncbi.nlm.nih.gov
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ABSTRACT: Prevention is a challenging area of primary care. In Switzerland, little is known about attitudes to and performance of screening and prevention services in general practice. To implement prevention services in primary care it is important to know about not only potential facilitators but also barriers. Primary care encompasses the activities of general practitioners, including those with particular interest and/or specializations (eg, pediatrics, gynecology). The aim of this study was to review all studies with a focus on prevention services which have been conducted in Switzerland and to reveal barriers and facilitators for physicians to participate in any preventive measures.
The Cochrane Library, PubMed, EMBASE and BIOSIS were searched from January 1990 through December 2010. Studies focussing on preventive activities in primary care settings were selected and reviewed. The methodological quality of the identified studies was classified according to the guidelines in the Consolidated Standards of Reporting Trials (CONSORT) statement.
We identified 49 studies including 45 descriptive studies and four randomised controlled trials (RCTs). Twelve studies addressed the prevention of epidemics, eleven out of them vaccinations. Further studies focused on lifestyle changes, physical activity counselling, smoking cessation, cardiovascular prevention and cancer screening. Perceived lack of knowledge/training and lack of time were the most commonly stated barriers. Motivation, feasibility and efficiency were the most frequently reported supporting factors for preventive activities. The methodological quality was weak, only one out of four RCTs met the applied quality criteria.
Most studies focussing on screening and prevention activities in primary care addressed vaccination, lifestyle modification or cardiovascular disease prevention. Identified barriers and facilitators indicate a need for primary-care-adapted education and training which are easy to handle, time-saving and reflect the specific needs of general practitioners. If new prevention programs are to be implemented in general practices, RCTs of high methodological quality are needed to assess their impact.
Available from: ncbi.nlm.nih.gov
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