High-risk patients identified by program but only 57% medicated

Providing quality care for patients at risk for cardiovascular disease relies on improving both identification and properly medicating those patients at highest risk. An Australian-based randomized cluster study succeeded on increasing one part of that equation, but not the other.

A team led by David Peiris, MBBS, MIPH, PhD, from The George Institute for Global Health at the University of Sydney, created a program that linked electronic health systems used at 60 Sydney health centers. The intent was to both identify high-risk patients and ensure that their risk was lowered through appropriate medication. They randomized study centers; half had the interventional tools, half maintained standard care. The intervention occurred between 2011 and 2012; patients were followed for a mean 17.5 months.

Risk factor measurements improved in the intervention compared to the control (62.8 percent vs. 53.4 percent). Prescriptions  increased: Antiplatelet use increased six-fold and lipid-lowering and blood pressure-lowering medications approximately doubled.

However, recommended prescription rates for high-risk patients were not significantly different between intervention and control (56.8 percent vs. 51.2 percent), nor were they significantly improved over baseline (46.7 percent vs. 52.8 percent).

High-risk patients, likewise, did not have significant improvements in mean blood pressure or cholesterol in the study period. "The escalation in guideline-based care indicates the intervention was effective in reducing practitioner therapeutic inertia (the failure to initiate or increase therapy when treatment goals are not met) although it must be emphasized that absolute rates of treatment remained unacceptably low,” Peiris et al wrote.

They noted their findings should be considered when discussing comprehensive service delivery that utilizes EHR decision-making support and performance feedback for cardiovascular disease prevention. For quality improvement strategies to result in positive health benefits, future approaches need to consider gaps, they wrote.

The study was published online Jan. 13 in Circulation: Cardiovascular Quality and Outcomes.