The effect of a disease management algorithm and dedicated postacute coronary syndrome clinic on achievement of guideline compliance: results from the parkland acute coronary event treatment study

Jeff Yorio, Sundeep Viswanathan, Raphael See, Linda Uchal, Jo Ann McWhorter, Nali Spencer, Sabina Murphy, Amit Khera, James A de Lemos, Darren K McGuire

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background: The application of disease management algorithms by physician extenders has been shown to improve therapeutic adherence in selected populations. It is unknown whether this strategy would improve adherence to secondary prevention goals after acute coronary syndromes (ACSs) in a largely indigent county hospital setting. Methods: Patients admitted for ACS were randomized at the time of discharge to usual follow-up care versus the same care with the addition of a physician extender visit. Physician extender visits were conducted according to a treatment algorithm based on contemporary practice guidelines. Groups were compared using the primary end point of achievement of low-density lipoprotein treatment goals at 3 months after discharge and achievement of additional evidence-based practice goals. Results: One hundred forty consecutive patients were randomized. A similar proportion of patients returned for study follow-up in both groups at 3 months (54 [79%]/68 in the usual care group vs 57 [79%]/72 in the intervention group; P = 0.97). Among those completing the 3-month visit, a low-density lipoprotein cholesterol level less than 100 mg/dL was achieved in 37 (69%) of the usual care patients compared with 35 (57%) of those in the intervention group (P = 0.43). There was no statistical difference in implementation of therapeutic lifestyle changes (smoking cessation, cardiac rehabilitation, or exercise) between groups. Prescription rates of evidence- based therapeutics at 3 months were similar in both groups. Conclusion: The implementation of a post-ACS clinic run by a physician extender applying a disease management algorithm did not measurably improve adherence to evidence-based secondary prevention treatment goals. Despite initially high rates of evidence-based treatment at discharge, adherence with follow-up appointments and sustained implementation of evidence- based therapies remains a significant challenge in this high-risk cohort.

Original languageEnglish (US)
Pages (from-to)15-25
Number of pages11
JournalJournal of Investigative Medicine
Volume56
Issue number1
StatePublished - Jan 2008

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Disease Management
Compliance
Guidelines
Physician Assistants
Acute Coronary Syndrome
LDL Lipoproteins
Patient rehabilitation
LDL Cholesterol
Therapeutics
Secondary Prevention
County Hospitals
Exercise Therapy
Aftercare
Evidence-Based Practice
Smoking Cessation
Poverty
Practice Guidelines
Prescriptions
Life Style
Patient Care

Keywords

  • Evidence based therapeutics
  • Physician extender
  • Post-ACS care

ASJC Scopus subject areas

  • Biochemistry, Genetics and Molecular Biology(all)
  • Medicine(all)

Cite this

The effect of a disease management algorithm and dedicated postacute coronary syndrome clinic on achievement of guideline compliance : results from the parkland acute coronary event treatment study. / Yorio, Jeff; Viswanathan, Sundeep; See, Raphael; Uchal, Linda; McWhorter, Jo Ann; Spencer, Nali; Murphy, Sabina; Khera, Amit; de Lemos, James A; McGuire, Darren K.

In: Journal of Investigative Medicine, Vol. 56, No. 1, 01.2008, p. 15-25.

Research output: Contribution to journalArticle

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abstract = "Background: The application of disease management algorithms by physician extenders has been shown to improve therapeutic adherence in selected populations. It is unknown whether this strategy would improve adherence to secondary prevention goals after acute coronary syndromes (ACSs) in a largely indigent county hospital setting. Methods: Patients admitted for ACS were randomized at the time of discharge to usual follow-up care versus the same care with the addition of a physician extender visit. Physician extender visits were conducted according to a treatment algorithm based on contemporary practice guidelines. Groups were compared using the primary end point of achievement of low-density lipoprotein treatment goals at 3 months after discharge and achievement of additional evidence-based practice goals. Results: One hundred forty consecutive patients were randomized. A similar proportion of patients returned for study follow-up in both groups at 3 months (54 [79{\%}]/68 in the usual care group vs 57 [79{\%}]/72 in the intervention group; P = 0.97). Among those completing the 3-month visit, a low-density lipoprotein cholesterol level less than 100 mg/dL was achieved in 37 (69{\%}) of the usual care patients compared with 35 (57{\%}) of those in the intervention group (P = 0.43). There was no statistical difference in implementation of therapeutic lifestyle changes (smoking cessation, cardiac rehabilitation, or exercise) between groups. Prescription rates of evidence- based therapeutics at 3 months were similar in both groups. Conclusion: The implementation of a post-ACS clinic run by a physician extender applying a disease management algorithm did not measurably improve adherence to evidence-based secondary prevention treatment goals. Despite initially high rates of evidence-based treatment at discharge, adherence with follow-up appointments and sustained implementation of evidence- based therapies remains a significant challenge in this high-risk cohort.",
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