scholarly journals Lower‐Intensity Statins Contributing to Gaps in Care for Patients With Primary Severe Hypercholesterolemia

2021 ◽  
Author(s):  
Wael E. Eid ◽  
Emma Hatfield Sapp ◽  
Elijah Flerlage ◽  
Joseph R. Nolan
Keyword(s):  
Medical Record ◽  
Electronic Medical Record ◽  
Treatment Guidelines ◽  
Primary Care Providers ◽  
Lipid Lowering ◽  
Moderate Intensity ◽  
Lipid Lowering Therapy ◽  
Care Providers ◽  
Group 2 ◽  
Group 1

Background Although severe hypercholesterolemia confers a 5‐fold increased long‐term risk for coronary artery disease, treatment guidelines may not be fully implemented, leading to underdiagnosis and suboptimal treatment. To further understand the clinical features and gaps in treatment approaches, we analyzed electronic medical record data from a midwestern US multidisciplinary healthcare system, between 2009 and 2020. Methods and Results We retrospectively assessed the prevalence, clinical presentation, and treatment characteristics of individuals currently treated with statin therapy having a low‐density lipoprotein cholesterol (LDL‐C) value that is either (1) an actual maximum electronic medical record–documented LDL‐C ≥190 mg/dL (group 1, n=7542) or (2) an estimated pretreatment LDL‐C ≥190 mg/dL (group 2, n=7710). Comorbidities and prescribed lipid‐lowering therapies were assessed. Statistical analyses identified differences among individuals within and between groups. Of records analyzed (n=266 282), 7% met the definition for primary severe hypercholesterolemia. Group 1 had more comorbidities than group 2. More individuals in both groups were treated by primary care providers (49.8%–53.0%, 32.6%–36.4%) than by specialty providers (4.1%–5.5%, 2.1%–3.3%). High‐intensity lipid‐lowering therapy was prescribed less frequently for group 2 than for group 1, but moderate‐intensity statins were prescribed more frequently for group 2 (65%) than for group 1 (52%). Conclusions Two percent of patients in our study population being treated with low‐ or moderate‐intensity statins have an estimated LDL‐C ≥190 mg/dL (indicating severe hypercholesterolemia), but receive less aggressive treatment than patients with a maximum measured LDL‐C ≥190 mg/dL.

scholarly journals Adoption of an Electronic Medical Record Tool for Childhood Obesity by Primary Care Providers

2020 ◽  
Vol 11 (02) ◽  
pp. 210-217
Author(s):  
Amy Williams ◽  
Christy Turer ◽  
Jamie Smith ◽  
Isabelle Nievera ◽  
Laura McCulloch ◽  
...  
Keyword(s):  
Primary Care ◽  
Childhood Obesity ◽  
Medical Record ◽  
Electronic Medical Record ◽  
Primary Care Providers ◽  
Perceived Usefulness ◽  
Intention To Use ◽  
Care Providers ◽  
Perceived Usability ◽  
Strongly Agree

Abstract Background Primary care providers are tasked with the increasingly difficult job of addressing childhood obesity during clinic visits. Electronic medical record (EMR)-enabled decision-support tools may aid providers in this task; however, information is needed regarding whether providers perceive such tools to be useful for addressing nutrition and physical activity lifestyle behaviors. Objectives This study aimed to evaluate the usefulness and usability of FitTastic, an EMR-enabled tool to support prevention and management of childhood obesity in primary care. Methods In this mixed-method study, we implemented the FitTastic tool in two primary-care clinics, then surveyed and conducted focused interviews with providers. Validated Technology Acceptance Model perceived usefulness and National Aeronautics and Space Administration (NASA) perceived usability survey questions were e-mailed to 60 providers. In-depth provider interviews with family medicine and pediatric physicians (n = 12) were used to further probe adoption of FitTastic. Results Surveys were completed by 73% of providers (n = 44). The mean score for FitTastic's usefulness was 3.3 (standard deviation [SD] = 0.54, scale 1–5, where 5 is strongly agree) and usability, 4.8 (SD = 0.86, scale 1–7, where 7 is strongly agree). Usefulness and usability scores were associated with intention to use FitTastic (correlation for both, p < 0.05). Data from provider interviews indicated that useful features of FitTastic included: standardizing the approach to childhood obesity, and facilitating conversations about weight management, without increasing cognitive workload. However, use of FitTastic required more time from nurses to input lifestyle data. Conclusion FitTastic is perceived as a useful and usable EMR-based lifestyle behavior tool that standardizes, facilitates, and streamlines healthy lifestyle conversations with families. Perceived usability and usefulness scores correlated with provider intention-to-use the technology. These data suggest that EMR-based child obesity prevention and management tools can be feasible to use in the clinic setting, with potential for scalability. Usefulness can be optimized by limiting amount of time needed by staff to input data.

scholarly journals Changes in plasma sphingolipid levels against the background of lipid-lowering therapy in patients with premature atherosclerosis

2021 ◽  
Author(s):  
AA Rogozhina ◽  
AV Alessenko ◽  
IN Kurochkin ◽  
LO Minushkina ◽  
UA Gutner ◽  
...  
Keyword(s):  
Total Cholesterol ◽  
Statin Therapy ◽  
Plasma Lipids ◽  
Lipid Lowering ◽  
Premature Coronary Artery Disease ◽  
Lipid Lowering Therapy ◽  
Dynamic Changes ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Lipid-lowering drugs affect standard lipoproteins. However, we have no knowledge of changes in other plasma lipids upon treatment. The study was aimed to assess the dynamic changes in cholesterol, high- and low-density lipoproteins (HDL and LDL), triglycerides, and sphingolipids against the background of lipidlowering therapy in patients with premature coronary artery disease, atherosclerosis and hypercholesterolemia. A total of 18 patients were enrolled (the average age was 53 ± 6.7 years): in group 1, six patients received starting statin doses; group 2 included six patients, who failed to achieve LDL target levels against the background of treatment with starting statin doses, and received escalated statin doses; seven patients in group 3 failed to achieve LDL target levels against the background of treatment with maximum tolerated doses of statins and ezetimibe, and received alirocumab. Sphingolipid levels were assessed by mass spectrometry. In group 1, the decreased levels of ceramide Cer 14:1 (p = 0.046) and sphingomyelins SM 22:1, SM 22:0, SM 24:0 (p = 0.028) were observed. There were no significant changes in the levels of total cholesterol, LDL-C, HDL-C, and triglycerides. In group 2, the significantly decreased levels of total cholesterol (p = 0.028), LDL (p = 0.043), sphingomyelins SM 18:1, SM 24:1 and SM 26:1, and ceramide Cer 16:1 (p = 0.028) were observed. The level of Cer 22:1 significantly increased (p = 0.028). In group 3, total cholesterol decreased by 36.2%, and LDL-C (p = 0.018) decreased by 60.1% compared to baseline (ΔLDL-C = –2.67 ± 3.12); the elevated levels of ceramide Cer 22:1 (p = 0.028) were observed. It has been shown, that decreased sphingomyelin levels are associated with statin therapy and correlate with decreased levels of LDL-C. No significant dynamic changes in ceramides and ceramide risk against the background of statin therapy were observed, however, PCSK9 inhibitor added to therapy reduced the Cer 16:0/24:0 ratio.

Using the electronic medical record to identify and follow survivors of pediatric malignancies.

2012 ◽  
Vol 30 (34_suppl) ◽  
pp. 302-302
Author(s):  
Elizabeth Bell ◽  
Robert Michael Cooper ◽  
Lisa Mueller
Keyword(s):  
At Risk ◽  
Cancer Treatment ◽  
Childhood Cancer ◽  
Medical Record ◽  
Electronic Medical Record ◽  
Late Effects ◽  
Kaiser Permanente ◽  
Pediatric Malignancies ◽  
Group 2 ◽  
Group 1

302 Background: There are currently more than 328,000 survivors of pediatric malignancies in the United States (NCI, The Childhood Cancer Survivor Study: An Overview, http://www.cancer.gov/cancertopics/coping/ccss . 6/6/2012). These survivors are at risk for significant late effects from their cancer treatments (Childhood Cancer Survivors Study (Oeffinger, et al, NEJM 2006)). The Kaiser Permanente health care system has good insurance retention of patients treated for pediatric malignancies. Kaiser also uses an electronic medical record, which improves our ability to identify survivors and follow them over time to identify and manage late effects of cancer treatment. The Children’s Oncology Group (COG) has released a summary of cancer treatment form and specific guidelines for follow-up based on patients’ treatment. Methods: In 2010, we queried the Kaiser Permanente Southern California Cancer Registry for all patients who were diagnosed with a malignancy under the age of 18 from 1980 to 2009. This was cross-referenced with list of current Kaiser members as of 2010. We created a database of the current members and their diagnosis, treatment center, age at diagnosis, date of diagnosis, current age, years of survivorship, and sex. We divided the patients into priority groups: (1) more than 5 years from diagnosis and over age 18, (2) more than 5 years from diagnosis and less than age 18, and (3) less than 5 years from diagnosis. We began to prepare summaries of cancer treatment for the groups using the COG form. Results: We identified 1,267 survivors of pediatric malignancies who were Kaiser members in 2010. 54% are still Kaiser members 10 years after diagnosis. There were 611 in Group 1, 293 in Group 2, and 363 in Group 3. We have prepared summaries of cancer treatment including late effects for 400 of the survivors, 360 from Group 1, and 40 from Group 2. Conclusions: The combination of an electronic medical record and insurance retention allows us to identify and track survivors of pediatric malignancies into adulthood. With completed summaries of cancer treatment we will be able to quickly identify at-risk populations for monitoring and potential interventions.

Insights From an Usability Review of an Electronic Medical Record–Integrated Physical Activity Counseling Tool for Primary Care

2020 ◽  
pp. 106480462098214
Author(s):  
Bobby Neudorf ◽  
Lora Giangregorio ◽  
Plinio Morita
Keyword(s):  
Physical Activity ◽  
Primary Care ◽  
Medical Record ◽  
Electronic Medical Record ◽  
Primary Care Providers ◽  
Care Plan ◽  
Care Providers ◽  
Physical Activity Counseling ◽  
Activity Counseling ◽  
Workflow Integration

This study assessed primary care providers’ (PCPs) perceptions of the usability of an electronic medical record tool to support physical activity counseling in primary care. Our analyses revealed that usability improved when the electronic medical record tool followed a PCP’s natural workflow and when the tool could assist in engaging in a discussion about physical activity. Poor usability was associated with the presence of large amounts of text on the screen and technological aspects that required additional learning. Overall, efficiency, workflow integration, and the inclusion of a care plan were vital in a physical activity counseling tool for a primary care setting.

scholarly journals Will mild atypical pneumonia remain underdiagnosed and undertreated in primary care setting?

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
S Gatsura ◽  
V Deriushkin ◽  
O Gatsura ◽  
E Ulyanova
Keyword(s):  
Primary Care ◽  
Medical Students ◽  
Primary Care Physicians ◽  
Primary Care Providers ◽  
Atypical Pneumonia ◽  
Care Providers ◽  
Beta Lactams ◽  
Atypical Pathogens ◽  
Group 2 ◽  
Group 1

Abstract Background Non severe community acquired pneumonia (CAP) is a common problem in primary care. So called “walking” CAP is frequently caused by atypical intracellular pathogens Chlamydia pneumoniae and Mycoplasma pneumonia which are resistant to beta-lactams and can be transmitted from an infected person to a healthy one. Taking into account medical and epidemiologic importance of this problem we aimed to estimate appropriateness of the antimicrobial agent (AM) choice for outpatient treatment of mild CAP by current and future primary care providers with regard to atypical pathogens coverage. Methods Total 240 final year medical students of A.I.Yevdokimov Moscow State University of Medicine and Dentistry (Group 1) and 206 Moscow primary care physicians (Group 2) were surveyed in 2019. Respondents were asked to specify in writing what particular AM they would recommend to 35 year old previously healthy male patient with subfebrile body temperature (37.3 °C), non-productive cough and documented CAP. Chi-square test was used to compare the data obtained in both groups. Results Group 1 respondents returned questionnaires with 271 recommendations, Group 2 participants named 230 items. AMs with atypical pathogens coverage (macrolides, fluoroquinolones and doxycycline) accounted for just 33.2% in Group 1 versus 20.0% in Group 2 (p=.0009). Amoxicillin/clavulanate was the leading choice equally popular both in students and physicians (42.1% and 40.9% respectively). The rest of recommendations in both Groups included amoxicillin and various cephalosporins. Conclusions Only one of three students and one of five physicians made the right choice in offered clinical scenario. A majority of respondents in both groups hastily recommended beta-lactams instead of clinical estimation of atypical CAP probability in given situation, but students indicated appropriate AMs more often. This problem obviously persists and requires action from both academics and healthcare managers. Key messages Medical students and primary care physicians’ awareness of atypical CAP presentation and treatment is not quite satisfactory. Resulting undertreatment of atypical CAP may harm the patient and promote further spread of causative pathogen within the community.

scholarly journals The auto-call as an impactful technical tool in increasing adherence to lipid-lowering therapy and patient outcome in ambulatory settings: 1-year experience at tertiary cardiology center

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
T.V Fofanova ◽  
M.D Smirnova ◽  
F.T Ageev
Keyword(s):  
Patient Outcome ◽  
Treatment Adherence ◽  
Density Lipoprotein ◽  
Lipid Lowering ◽  
Lipid Lowering Therapy ◽  
Technical Tool ◽  
Lowering Therapy ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Abstract Background Long-term adherence to lipid-lowering treatment is a challenge. Purpose To develop a technical tool, an auto-call program, aimed to increase patient adherence to lipid-lowering therapy, and patient outcome in ambulatory care. Methods 919 ambulatory patients were studied, divided to three groups: with low or moderate risk of developing atherosclerosis complications (Group 1); with high or very high risk of atherosclerosis complications, but without coronary artery disease (CAD) symptoms (Group 2); patients with symptomatic CAD (Group 3). At baseline, patients were invited to participate in the auto-call program (call-reminder to take the medication); the duration of study was 1 year. 663 patients (71.3%) consented to auto-calls received, 256 patients (28.7%) declined auto-calls. These two groups were comparable according to age, gender, the presence of comorbidities, the level of baseline adherence to lipid-lowering therapy, and the level of anxiety and depression. Treatment adherence was evaluated using Morisky-Green Medication Adherence Scale. Results Group 1. After 1 year, the auto-call group showed a significantly higher degree of decrease in low-density lipoprotein cholesterol, LDL-C (p=0.001) and triglyceride, TG (p=0.002), and increase in high-density lipoprotein cholesterol, HDL-C (p=0.03) compared to the auto-call rejection group. Group 2. After 1 year, the auto-call group showed a significantly higher degree of decrease in total cholesterol, TC (p&lt;0.02) and LDL-C (p&lt;0.01), and increase in HDL-C (p=0.2) compared to the auto-call rejection group. Moreover, in the auto-call group, the baseline TC level was higher (6.4±1.5 mmol/l vs 6.0±1.4 mmol/l, p=0.03). Group 3. After 1 year, the auto-call group showed a significantly higher degree of decrease in TC (p&lt;0.005) and TG (p&lt;0.05). The degree of decline in LDL-C was higher in the auto-call group (−25.9 (−27.3; −17.0) vs −20.1 (−21.3; −0.2), however, non-significant. After 1 year, treatment adherence increased in the total cohort from 1.91 score (1.80; 2.02) to 2.6 score (2.52; 2.80), p&lt;0.000001. However, in Group 3, a significant increase in scores from 2.0 (1.9; 2.2) to 3.0 (2.6; 3.1) was observed only in the auto-call group (p&lt;0.00001). In Group 1 and Group 2, the increase in adherence did not depend on the presence or absence of auto-calls. It should be noted that adherence to therapy in patients of Group 3 was significantly higher at baseline (2.0 (1.9; 2.2) than in Group 1 (1.7 (1.6; 1.9), p&lt;0.005) and Group 2 (1.9 (1.7; 2.1), p&lt;0.05), respectively. Conclusions Utilizing a high-tech auto-call reminder tool in patients with hyperlipidemia and CAD was associated with increased adherence to lipid-lowering therapy, which, in turn, resulted in significant decrease in LDL-C compared to patients who declined to participate in the auto-call program. Funding Acknowledgement Type of funding source: None

Primary signs of vasular inflammation in children with familial hypercholesterolemia

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
E Slastnikova ◽  
D.I Sadykova ◽  
L.F Galimova ◽  
N.E Usova
Keyword(s):  
Endothelial Function ◽  
Familial Hypercholesterolemia ◽  
Lipid Lowering ◽  
High Density Lipoproteins ◽  
Lipid Lowering Therapy ◽  
Premature Atherosclerosis ◽  
Reactive Protein ◽  
Heterozygous Familial Hypercholesterolemia ◽  
Group 2 ◽  
Group 1

Abstract   Familial hypercholesterolemia is one of the most common genetic diseases that leads to premature atherosclerosis. We investigated endothelial function in children with heterozygous familial hypercholesterolemia in order to detect the first signs of endothelial inflammation in non-invasive ways. In 57 children with heterozygous familial hypercholesterolemia (Group 1), endothelial function was studied by measuring levels of nitric oxide (NO), endothelin and hypersensitive C-reactive protein (hsCRP). All secondary causes that could lead to a change in these indicators were excluded. Children from Group 1 had no Clinical or ultrasound signs of atherosclerosis. No children from Group 1 were ever treated by statins or other lipid-lowering therapy. Results were compared with a group of children comparable in age and sex (Group 2). Average age of Group 1 was 9 years old ±2 months, Group 2 is 9 years old ±3 months. Average lipid values in Group 1: total cholesterol (TH) – 7.2±0.9 mmol/L, low density lipoproteins (LDL) – 4.7±0.7 mmol/L, triglycerides and high density lipoproteins (HDL) corresponded to normal. Group 2 average lipids: TH – 4.2±0.7 mmol/L, LDL – 2.3±0.4 mmol/L, the level of triglycerides and (HDL) corresponded to normal. Results The results in Group 1 were: NO 66.15±1.19 μmol/L, endothelin 0.418±0.121 pmol/L, hsCRP 0.25±0.1 mg/dl. They showed in Group 2: NO 39.15±0.15 μmol/L, endothelin 0.231±0.05 pmol/L, hsCRP 0.11±0.2 mg/dl. The results in group 1 were significantly higher (endothelin and hypersensitive reactive protein) and lower (NO) in terms of indicators. Conclusions There is significant difference in the levels of vasodilators, vasoconstrictors and hsCRP between Group 1 and Group 2, that means there are the signs of inflammation in the Children with no clinics of peripheral or coronary atherosclerosis. It can be used as biomarkers of premature atherosclerosis and can help to avoid it. Funding Acknowledgement Type of funding source: None

scholarly journals Evaluation of a Pilot Asthma Care Program for Electronic Communication between School Health and a Healthcare System’s Electronic Medical Record

2016 ◽  
Vol 07 (04) ◽  
pp. 969-982 ◽  
Author(s):  
Yhenneko Taylor ◽  
Hazel Tapp ◽  
Thomas Ludden ◽  
Lindsay Shade ◽  
Beth Burton ◽  
...  
Keyword(s):  
Primary Care ◽  
Medical Record ◽  
Electronic Medical Record ◽  
School Health ◽  
Electronic Communication ◽  
Care Program ◽  
Primary Care Providers ◽  
School Nurse ◽  
School Nurses ◽  
Care Providers

SummaryObjective Asthma is a common childhood chronic lung disease affecting greater than 10% of children in the United States. School nurses are in a unique position to close gaps in care. Indeed, effective asthma management is more likely to result when providers, family, and schools work together to optimize the patient’s treatment plan. Currently, effective communication between schools and healthcare systems through electronic medical record (EMR) systems remains a challenge. The goal of this feasibility pilot was to link the school-based care team with primary care providers in the healthcare system network via electronic communication through the EMR, on behalf of pediatric asthma patients who had been hospitalized for an asthma exacerbation. The implementation process and the potential impact of the communication with providers on the reoccurrence of asthma exacerbations with the linked patients were evaluated.Methods By engaging stakeholders from the school system and the healthcare system, we were able to collaboratively design a communication process and implement a pilot which demonstrated the feasibility of electronic communication between school nurses and primary care providers. Outcomes data was collected from the electronic medical record to examine the frequency of asthma exacerbations among patients with a message from their school nurse. The percent of exacerbations in the 12 months before and after electronic communication was compared using McNemar’s test.ResultsThe pilot system successfully established communication between the school nurse and primary care provider for 33 students who had been hospitalized for asthma and a decrease in hospital admissions was observed with students whose school nurse communicated through the EMR with the primary care provider.Conclusions Findings suggest a collaborative model of care that is enhanced through electronic communication via the EMR could positively impact the health of children with asthma or other chronic illnesses.Citation: Reeves KW, Taylor Y, Tapp H, Ludden T, Shade LE, Burton B, Courtlandt C, Dulin M. Evaluation of a pilotasthma care program for electronic communication between school health and a healthcare system’s electronic medicalrecord.

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