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26-09-2011 | Cardiology | Article

Collaborative care ‘modestly improves’ guideline-focused treatment


Free abstract

MedWire News: Collaborative care modestly improves guideline-concordant treatment of patients with coronary heart disease and is well accepted by primary care providers (PCPs), report US researchers.

Findings suggest that such intervention facilitates the communication of clinical information between PCPs and specialists, write Stephan Fihn (University of Washington) and co-authors in the Archives of Internal Medicine.

Their prospective trial included 703 patients with symptomatic ischemic heart disease who were recruited from primary care clinics.

The findings revealed that overall, the 183 PCPs participating in the study implemented 91.6% of the 701 recommendations made by the collaborative care teams.

Almost half of these recommendations were related to medications, including adjustments to beta blockers, long-acting nitrates, and statins.

Although the endpoints favored the collaborative care intervention for 10 of 13 prespecified measures that included guideline concordance score, satisfaction with provider, and treatment satisfaction, collaborative care did not significantly improve symptoms of angina or self-perceived health.

From baseline to 12-month follow-up, concordance with practice guidelines (measured using a summed scoring system ranging from 0 to 4, assigned for guideline-concordant antiplatelet therapy, lipid-lowering therapy, anti-anginal treatment; and prior exercise stress test, cardiac stress imaging, or coronary angiogram for diagnosis and risk stratification) improved by 4.5% more among patients receiving collaborative care than those receiving usual care (p<0.01).

However, this was primarily due to the increased use of diagnostic testing rather than the increased use of recommended medications, explain the authors.

The avid uptake of recommendations by PCPs may be due to the fact that the recommendations were evidence-based and provided by respected colleagues, suggest the authors.

In a related editorial, Patrick O'Malley (Uniformed Services University, Bethesda, Maryland, USA) wrote: "It will be necessary to prioritize those conditions that benefit the most from collaborative care and determine the most cost-effective models."

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By Piriya Mahendra

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