Collaborative care improves cholesterol management in diabetic patients
MedWire News: A team-based care approach is effective for cholesterol management in patients with diabetes mellitus, say US researchers.
The study, involving nearly 7000 diabetic patients cared for by 68 physicians in nine clinics, found that a physician-pharmacist collaborative care approach resulted in considerable improvements in low-density lipoprotein (LDL) cholesterol levels and goal attainment after 2 years.
Ginger Pape (Providence Medical Group, Portland, Oregon) and colleagues randomly assigned clinics to either the control or intervention arm of the study. All clinicians had access to the health information technology tool CareManager, which provided automated diabetes mellitus-related point-of-care prompts, a web-based registry, and performance feedback with benchmarking.
The intervention included a physician-pharmacist team, in which a pharmacist was stationed at a remote site serving multiple clinic locations. The collaborative team was instructed to focus primarily on cholesterol management in diabetes.
After 24 months of follow-up, 78% of patients in the intervention arm achieved their target LDL cholesterol level (100 mg/dl (2.59 mmol/l) or lower) compared with 50% of controls. Furthermore, the mean LDL cholesterol level was a significant 12 mg/dl (0.31 mmol/l) lower in the intervention arm compared with the control arm.
Among high-risk patients with diabetes mellitus and comorbid coronary heart disease, the LDL cholesterol goal attainment rate in the intervention arm reached 86%.
"Translating this impact to long-term patient outcomes based on published evidence, a 3% absolute reduction in cardiovascular event risk over 10 years through sustained achievement of lower lipid values was estimated," write Pape et al in the Archives of Internal Medicine.
They add that the rate of LDL cholesterol testing was significantly higher in the intervention arm compared with the control arm, and that patients in the intervention arm were 15% more likely to receive a prescription for a lipid-lowering medication.
However, the intervention seemed to have little impact on patient satisfaction; of the 29% of patients who responded to the patient satisfaction survey, satisfaction was high in both groups (5.2 for the control arm; 5.4 for the intervention arm, out of a maximum 8.0) and not significantly different between groups.
In an accompanying editorial, Patrick O'Malley (Uniformed Services University, Bethesda, Maryland, USA) noted that, although collaborative care appears to be effective in achieving improvements in process measures of care, "this may not be enough to improve clinically relevant outcomes."
He concluded: "It will be necessary to prioritize those conditions that benefit the most from collaborative care and determine the most cost-effective models of delivering collaborative care within the medical home or remotely."
MedWire (www.medwire-news.md) is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2011
By Nikki Withers