The Role of Usual Source of Care in Cholesterol Treatment

The Journal of the American Board of Family Medicine

Kevin Fiscella¹  Daniel Tancredi²  Paul Winters¹ 

[1] Departments of Family Medicine and Community and Preventive Medicine, University of Rochester, New York (PW, KF);Department of Pediatrics, Center for Healthcare Policy and Research, University of California at Davis (DT)

关键词: Cholesterol;    Usual Source of Care;    Lipid;    Statin;    NHANES;    Data Pooling;   

DOI  :  10.3122/jabfm.2010.02.090084

学科分类：过敏症与临床免疫学

来源: The American Board of Family Medicine

【 摘 要 】

Background: A usual source of care (USOC) has been associated with improved preventive and chronic care, but its relationship with lipid management has not been well described. The objectives of this study were (1) to examine the association of USOC with statin use among persons meeting eligibility guidelines for treatment, and (2) to examine the association of USOC with low-density lipoprotein goal attainment among those receiving statins.

Methods: We examined statin use among adults aged 21 to 79 years who participated in the National Health and Nutrition Examination Survey, 1999 to 2006. We used criteria from the third Adult Treatment Panel about the treatment of high cholesterol to assess eligibility and the examined factors that predicted current use of statins. Among those currently taking statins, we assessed achievement of target low-density lipoprotein cholesterol based on the third Adult Treatment Panel's goals.

Results: Among the 12,979 participants, nearly 14% were eligible. Having a USOC was significantly associated with the use of statins among those who were eligible but not with goal attainment among those taking statins. Significant predictors of goal attainment were higher income and education and being in a more recent cohort.

Conclusion: In a national sample USOC was significantly associated with the use of statins among eligible adults but not with low-density lipoprotein cholesterol goal attainment for those using statins.

• Cholesterol
• Usual Source of Care
• Lipid
• Statin
• NHANES
• Data Pooling

Having a usual source of care (USOC; eg, first contact) is a core feature of primary care and is embedded in the principles of the patient-centered medical home.¹ Having a USOC has been associated with improved access to care, improved receipt of preventive care, ^2,3 weight loss among patients screened for hypertension or cholesterol, and improved communication, ⁴ adherence, and health status.⁵ When a USOC is combined with provider accessibility and well-organized care, key health care disparities are eliminated.⁶ Disruptions in USOC are associated with emergency department visits⁷ and avoidable hospitalizations.⁸ USOC is also associated with better chronic care management and disease control for human immunodeficiency virus, asthma, hypertension, and diabetes.^9–13

There are few data regarding the impact of continuity of care on cholesterol management beyond improvements in cholesterol screening.^14,15 Using recent national data, we examined 2 questions: (1) Is continuity of care associated with appropriate treatment of high cholesterol with statins? and (2) Is continuity of care associated with attainment of low-density lipoprotein (LDL) goals among persons currently being treated with statins?

【 授权许可】

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