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Intervention May Improve Cholesterol Management

Intervention for primary practices includes use of a computerized decision support system

WEDNESDAY, April 15 (HealthDay News) -- Cholesterol management in primary care practices may be improved by a multifaceted intervention that includes guideline dissemination, academic detailing audit and feedback, and provision of a personal digital assistant to provide Framingham risk scores and National Cholesterol Education Program Third Adult Treatment Panel (ATP III) recommended treatment, according to a study published in the April 13 issue of the Archives of Internal Medicine.

Alain G. Bertoni, M.D., of the Wake Forest University School of Medicine in Winston-Salem, N.C., and colleagues randomly assigned 61 primary care family and internal medicine practices to either the multifaceted intervention or a control intervention.

Overall, the researchers found that the multifaceted intervention was associated with stable adherence to the ATP III guidelines, while the control intervention was associated with a decline in guideline adherence. They reported that the modest relative improvement was largely due to overtreatment rates, which decreased from 6.6 percent to 3.9 percent in the multifaceted intervention group and increased from 4.2 percent to 6.4 percent in the control group, and a smaller increase in undertreatment rates.

"The overall appropriateness of management indicates substantial room for improvement," the authors write. "Future efforts, focused on enhancing the management of lipid levels using a computerized decision support system, likely need to incorporate features suggested in other trials to enhance success, including provision of automatic decision support as part of the clinic flow, especially when and where decisions are made."

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