An Educational Intervention to Improve Statin Use: Cluster RCT at the Primary Care Level in Argentina

被引:12
|
作者
Gulayin, Pablo E. [1 ]
Lozada, Alfredo [2 ]
Beratarrechea, Andrea [1 ]
Gutierrez, Laura [1 ]
Poggio, Rosana [1 ]
Martin Chaparro, Raul [1 ]
Santero, Marilina [1 ]
Masson, Walter [3 ]
Rubinstein, Adolfo [4 ]
Irazola, Vilma [1 ]
机构
[1] Inst Clin Effectiveness & Hlth Policy, Res Chron Dis Dept, Buenos Aires, DF, Argentina
[2] Austral Univ, Lipid Clin, Pilar, Argentina
[3] Buenos Aires Italiano Hosp, Buenos Aires, DF, Argentina
[4] Natl Minist Hlth, Buenos Aires, DF, Argentina
关键词
MEDICATION ADHERENCE; ELDERLY-PATIENTS; OUTREACH VISITS; MIDDLE-INCOME; HEALTH-CARE; PREVENTION; POINT; RISK; CHOLESTEROL; THERAPY;
D O I
10.1016/j.amepre.2019.02.018
中图分类号
R1 [预防医学、卫生学];
学科分类号
1004 ; 120402 ;
摘要
Introduction: Statins are essential drugs for high cardiovascular disease (CVD) risk management; however, there is still low adherence to good clinical practice guidelines for statin use at the primary care level in low- and middle-income countries. This study aimed to test whether a complex intervention targeting physicians improves treatment and control of hypercholesterolemia among patients with moderate to high CVD risk in Argentina. Study design: Cluster RCT. Setting/participants: Ten primary care centers from the public healthcare system of Argentina. Intervention: Primary care physicians in the intervention group received an educational program with three main components: (1) an intensive 2-day training workshop; (2) educational outreach visits; and (3) a mobile health application installed on the physician's smartphones. Main outcome measures: Reduction in mean low-density lipoprotein cholesterol level, reduction in mean Framingham risk score, proportion of patients receiving an appropriate statin dose, and mean annual number of primary care center visits. Results: Data were analyzed in 2017-2018. Between April 2015 and April 2016, a total of 357 participants were enrolled (179 patients in the intervention group and 178 in the control group). The global follow-up rate was 97.2%. At the end of the follow-up period, there was no difference in low-density lipoprotein cholesterol levels in any of the follow-up points among the groups. Mean CVD risk had a significant net difference in the first 6 months in the intervention group versus the control group (-4.0, 95% CI = -6.5, -1.5). At the end of follow-up, there was an absolute 41.5% higher rate of participants receiving an appropriate statin dose in the intervention group versus the control group. Conclusions: Although the intervention did not reach a reduction in cholesterol levels, it had a significant positive impact on the promotion of adequate use of clinical practice guidelines. (C) 2019 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.
引用
收藏
页码:95 / 105
页数:11
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