Individualized Risk Communication and Outreach for Primary Cardiovascular Disease Prevention in Community Health Centers

Randomized Trial

Stephen D. Persell*, Tiffany Brown, Ji Young Lee, Shreya Shah, Eric Henley, Timothy Long, Stephanie Luther, Donald M. Lloyd-Jones, Muriel Jean-Jacques, Namratha R. Kandula, Thomas Sanchez, David W. Baker

*Corresponding author for this work

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Background-Many eligible primary cardiovascular disease prevention candidates are not treated with statins. Electronic health record data can identify patients with increased cardiovascular disease risk. Methods and Results-We performed a pragmatic randomized controlled trial at community health centers in 2 states. Participants were men aged ≥35 years and women ≥45 years, without cardiovascular disease or diabetes mellitus, and with a 10-year risk of coronary heart disease of at least 10%. The intervention group received telephone and mailed outreach, individualized based on patients' cardiovascular disease risk and uncontrolled risk factors, provided by lay health workers. Main outcomes included: documented discussion of medication treatment for cholesterol with a primary care clinician, receipt of statin prescription within 6 months, and low-density lipoprotein (LDL)-cholesterol repeated and at least 30 mg/dL lower than baseline within 1 year. Six hundred forty-six participants (328 and 318 in the intervention and control groups, respectively) were included. At 6 months, 26.8% of intervention and 11.6% of control patients had discussed cholesterol treatment with a primary care clinician (odds ratio, 2.79; [95% confidence interval, 2.25-3.46]). Statin prescribing occurred for 10.1% in the intervention group and 6.0% in the control group (odds ratio, 1.76; [95% confidence interval, 0.90-3.45]). The cholesterol outcome did not differ, and the majority of patients did not repeat lipid levels during follow-up. Conclusions-Risk communication and lay outreach increased cholesterol treatment discussions with primary care clinicians. However, most discussions did not result in statin prescribing. For outreach to be successful, it should be combined with interventions to encourage clinicians to follow contemporary risk-based cholesterol treatment guidelines. Clinical Trial Registration-URL: http://www.clincialtrials.gov. Unique identifier: NCT01610609.

Original languageEnglish (US)
Pages (from-to)560-566
Number of pages7
JournalCirculation: Cardiovascular Quality and Outcomes
Volume8
Issue number6
DOIs
StatePublished - Dec 1 2015

Fingerprint

Community Health Centers
Hydroxymethylglutaryl-CoA Reductase Inhibitors
Cardiovascular Diseases
Communication
Cholesterol
Primary Health Care
Odds Ratio
Confidence Intervals
Control Groups
Electronic Health Records
Therapeutics
Telephone
LDL Cholesterol
Prescriptions
Coronary Disease
Diabetes Mellitus
Randomized Controlled Trials
Clinical Trials
Guidelines
Lipids

Keywords

  • cardiovascular diseases
  • case management
  • cholesterol
  • randomized controlled trial
  • risk assessment

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

@article{f3936651354146738234cdb59704cdc7,
title = "Individualized Risk Communication and Outreach for Primary Cardiovascular Disease Prevention in Community Health Centers: Randomized Trial",
abstract = "Background-Many eligible primary cardiovascular disease prevention candidates are not treated with statins. Electronic health record data can identify patients with increased cardiovascular disease risk. Methods and Results-We performed a pragmatic randomized controlled trial at community health centers in 2 states. Participants were men aged ≥35 years and women ≥45 years, without cardiovascular disease or diabetes mellitus, and with a 10-year risk of coronary heart disease of at least 10{\%}. The intervention group received telephone and mailed outreach, individualized based on patients' cardiovascular disease risk and uncontrolled risk factors, provided by lay health workers. Main outcomes included: documented discussion of medication treatment for cholesterol with a primary care clinician, receipt of statin prescription within 6 months, and low-density lipoprotein (LDL)-cholesterol repeated and at least 30 mg/dL lower than baseline within 1 year. Six hundred forty-six participants (328 and 318 in the intervention and control groups, respectively) were included. At 6 months, 26.8{\%} of intervention and 11.6{\%} of control patients had discussed cholesterol treatment with a primary care clinician (odds ratio, 2.79; [95{\%} confidence interval, 2.25-3.46]). Statin prescribing occurred for 10.1{\%} in the intervention group and 6.0{\%} in the control group (odds ratio, 1.76; [95{\%} confidence interval, 0.90-3.45]). The cholesterol outcome did not differ, and the majority of patients did not repeat lipid levels during follow-up. Conclusions-Risk communication and lay outreach increased cholesterol treatment discussions with primary care clinicians. However, most discussions did not result in statin prescribing. For outreach to be successful, it should be combined with interventions to encourage clinicians to follow contemporary risk-based cholesterol treatment guidelines. Clinical Trial Registration-URL: http://www.clincialtrials.gov. Unique identifier: NCT01610609.",
keywords = "cardiovascular diseases, case management, cholesterol, randomized controlled trial, risk assessment",
author = "Persell, {Stephen D.} and Tiffany Brown and Lee, {Ji Young} and Shreya Shah and Eric Henley and Timothy Long and Stephanie Luther and Lloyd-Jones, {Donald M.} and Muriel Jean-Jacques and Kandula, {Namratha R.} and Thomas Sanchez and Baker, {David W.}",
year = "2015",
month = "12",
day = "1",
doi = "10.1161/CIRCOUTCOMES.115.001723",
language = "English (US)",
volume = "8",
pages = "560--566",
journal = "Circulation: Cardiovascular Quality and Outcomes",
issn = "1941-7713",
publisher = "Lippincott Williams and Wilkins",
number = "6",

}

Individualized Risk Communication and Outreach for Primary Cardiovascular Disease Prevention in Community Health Centers : Randomized Trial. / Persell, Stephen D.; Brown, Tiffany; Lee, Ji Young; Shah, Shreya; Henley, Eric; Long, Timothy; Luther, Stephanie; Lloyd-Jones, Donald M.; Jean-Jacques, Muriel; Kandula, Namratha R.; Sanchez, Thomas; Baker, David W.

In: Circulation: Cardiovascular Quality and Outcomes, Vol. 8, No. 6, 01.12.2015, p. 560-566.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Individualized Risk Communication and Outreach for Primary Cardiovascular Disease Prevention in Community Health Centers

T2 - Randomized Trial

AU - Persell, Stephen D.

AU - Brown, Tiffany

AU - Lee, Ji Young

AU - Shah, Shreya

AU - Henley, Eric

AU - Long, Timothy

AU - Luther, Stephanie

AU - Lloyd-Jones, Donald M.

AU - Jean-Jacques, Muriel

AU - Kandula, Namratha R.

AU - Sanchez, Thomas

AU - Baker, David W.

PY - 2015/12/1

Y1 - 2015/12/1

N2 - Background-Many eligible primary cardiovascular disease prevention candidates are not treated with statins. Electronic health record data can identify patients with increased cardiovascular disease risk. Methods and Results-We performed a pragmatic randomized controlled trial at community health centers in 2 states. Participants were men aged ≥35 years and women ≥45 years, without cardiovascular disease or diabetes mellitus, and with a 10-year risk of coronary heart disease of at least 10%. The intervention group received telephone and mailed outreach, individualized based on patients' cardiovascular disease risk and uncontrolled risk factors, provided by lay health workers. Main outcomes included: documented discussion of medication treatment for cholesterol with a primary care clinician, receipt of statin prescription within 6 months, and low-density lipoprotein (LDL)-cholesterol repeated and at least 30 mg/dL lower than baseline within 1 year. Six hundred forty-six participants (328 and 318 in the intervention and control groups, respectively) were included. At 6 months, 26.8% of intervention and 11.6% of control patients had discussed cholesterol treatment with a primary care clinician (odds ratio, 2.79; [95% confidence interval, 2.25-3.46]). Statin prescribing occurred for 10.1% in the intervention group and 6.0% in the control group (odds ratio, 1.76; [95% confidence interval, 0.90-3.45]). The cholesterol outcome did not differ, and the majority of patients did not repeat lipid levels during follow-up. Conclusions-Risk communication and lay outreach increased cholesterol treatment discussions with primary care clinicians. However, most discussions did not result in statin prescribing. For outreach to be successful, it should be combined with interventions to encourage clinicians to follow contemporary risk-based cholesterol treatment guidelines. Clinical Trial Registration-URL: http://www.clincialtrials.gov. Unique identifier: NCT01610609.

AB - Background-Many eligible primary cardiovascular disease prevention candidates are not treated with statins. Electronic health record data can identify patients with increased cardiovascular disease risk. Methods and Results-We performed a pragmatic randomized controlled trial at community health centers in 2 states. Participants were men aged ≥35 years and women ≥45 years, without cardiovascular disease or diabetes mellitus, and with a 10-year risk of coronary heart disease of at least 10%. The intervention group received telephone and mailed outreach, individualized based on patients' cardiovascular disease risk and uncontrolled risk factors, provided by lay health workers. Main outcomes included: documented discussion of medication treatment for cholesterol with a primary care clinician, receipt of statin prescription within 6 months, and low-density lipoprotein (LDL)-cholesterol repeated and at least 30 mg/dL lower than baseline within 1 year. Six hundred forty-six participants (328 and 318 in the intervention and control groups, respectively) were included. At 6 months, 26.8% of intervention and 11.6% of control patients had discussed cholesterol treatment with a primary care clinician (odds ratio, 2.79; [95% confidence interval, 2.25-3.46]). Statin prescribing occurred for 10.1% in the intervention group and 6.0% in the control group (odds ratio, 1.76; [95% confidence interval, 0.90-3.45]). The cholesterol outcome did not differ, and the majority of patients did not repeat lipid levels during follow-up. Conclusions-Risk communication and lay outreach increased cholesterol treatment discussions with primary care clinicians. However, most discussions did not result in statin prescribing. For outreach to be successful, it should be combined with interventions to encourage clinicians to follow contemporary risk-based cholesterol treatment guidelines. Clinical Trial Registration-URL: http://www.clincialtrials.gov. Unique identifier: NCT01610609.

KW - cardiovascular diseases

KW - case management

KW - cholesterol

KW - randomized controlled trial

KW - risk assessment

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