Testing a Community Outreach Intervention for Cardiovascular Disease Prevention
Providing individualized feedback about the risk of developing cardiovascular disease (CVD) to community health center patients increased cholesterol treatment discussions with their primary care physician, according to a new Northwestern Medicine study. However, this patient-centered outreach intervention did not increase statin prescribing for CVD prevention among patients in community-based settings.
The study, published in Circulation: Cardiovascular Quality and Outcomes, tested an intervention for identifying patients at increased risk for CVD via electronic health record (EHR) and administering personalized telephone and mail outreach by bilingual lay care managers encouraging patients to ask their doctor about CVD prevention.
“Many patients at risk of developing cardiovascular disease are not aware of the benefits of taking statins,” said Stephen Persell, MD MPH, director of the Center for Primary Care Innovation at the Institute for Public Health and Medicine and lead author of the study. “We conducted a randomized controlled trial to find out if an intervention would increase statin uptake among a vulnerable population.”
Dr. Persell and colleagues analyzed data from 646 community health care center patients in two states. Participants were men under 35 and women under 45 years of age, without CVD or diabetes and with a 10-year risk of coronary heart disease of at least 10 percent. At six months follow-up, they found a higher proportion of patients in the intervention group (26.8%) had had a discussion about cholesterol treatment with their primary care physician than in the control group (11.6%). In addition, 10.1% in the intervention group and 6.0% in the control group were prescribed a statin.
The study took place before the 2013 American College of Cardiology/American Heart Association adult cholesterol treatment guidelines strongly recommended the use of statins for CVD prevention among individuals with lower levels of cholesterol. “A new intervention based on this guideline might increase the proportion of at-risk patients being prescribed a statin,” Dr. Persell said.
Given the pragmatic design with a waiver of informed consent, the study shows the effectiveness of an outreach intervention in real-world settings delivered by trained lay educators. Future studies are needed to further investigate patient barriers to seeking treatment and acceptance and physician barriers to statin prescribing.
This study was funded by grant P01HS21141 from the Agency for Healthcare Research and Quality (AHRQ).