Physicians’ behavior following changes in LDL cholesterol target goals

Israel Journal of Health Policy Research

Arnon D Cohen²  Doron Comaneshter³  Haim Bitterman³  Shlomo Vinker¹ 

[1] Department of Family Medicine, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel;Siaal Family Medicine and Primary Care Research Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel;Chief Physician Office, Central Headquarter, Clalit Health Services, Tel Aviv, Israel

关键词: Statins;    Hypercholesterolemia;    Clinical guidelines;    Quality indicators;   

Others  :  1210469
DOI  :  10.1186/s13584-015-0016-9

 received in 2014-09-15, accepted in 2015-03-26,  发布年份 2015

【 摘 要 】

Background

In 01/2011 Clalit Health Services (CHS), changed the LDL-Cholesterol target definitions in its quality indicators program, from a universal target to values stratified by risk assessment based on ATP III criteria. The objective of this study is to evaluate the effect of this change on achievement of LDL-C targets and on physicians’ prescriptions of statins.

Study Design: A descriptive study based on administrative dataset 06/2010-06/2012.

Methods

Setting: CHS, The largest health maintenance organization in Israel that insures above 4,000,000 beneficiaries.

Patients: Patients who had been in the same risk group throughout the study period.

Measurements: Attainment of targets for LDL-C and purchases of statins prior to, and following, implementation of the guidelines in the CHS quality indicators program.

Results

433,662 patients remained in the same risk groups throughout the study period; 55.8% were women; the average age was 53.0 ± 10.3 years; 63.9%, 13.4%, and 22.7% were at low, medium, and high risk respectively. After implementation, the proportion of patients reaching LDL-C targets increased in all risk groups: from 58.6% to 61.6%, from 55.1% to 61.1%, and from 44.5% to 49.0%, in low, medium, and high risk groups respectively (p < 0.001). The proportion of patients treated with potent statins increased in all risk groups; from 3.4% to 5.6%, from 6.7% to 10.3%, and from 14.5% to 20.3% respectively (p < 0.001).

Conclusion

The risk stratification approach as a basis for the quality indicators program was implemented and better achievement of target LDL-C levels ensued. We suggest that implementation of quality indicators that are consistent with the current literature can lead to improvements that exceeds temporal trends.

【 授权许可】

   
2015 Vinker et al.; licensee BioMed Central.

【 图 表 】

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