Conclusions Organisational and professional interventions improved prescribing of statins/lipid-lowering agents and target blood pressure in patients with IHDs but there was little evidence of change in other outcomes .
Objectives Ischaemic heart diseases ( IHDs ) are a leading cause of death worldwide .
Although prescribing according to guidelines improves health outcomes , it remains suboptimal .
We determined whether interventions targeted at healthcare professionals are effective to enhance prescribing and health outcomes in patients with IHDs .
The Effect of a Disease Management Algorithm and Dedicated Postacute Coronary Syndrome Clinic on Achievement of Guideline Compliance
Background The application of disease management algorithms by physician extenders has been shown to improve therapeutic adherence in selected population s. It is unknown whether this strategy would improve adherence to secondary prevention goals after acute coronary syndromes ( ACSs ) in a largely indigent county hospital setting . Methods Patients admitted for ACS were r and omized at the time of discharge to usual follow-up care versus the same care with the addition of a physician extender visit . Physician extender visits were conducted according to a treatment algorithm based on contemporary practice guidelines . Groups were compared using the primary end point of achievement of low-density lipoprotein treatment goals at 3 months after discharge and achievement of additional evidence -based practice goals . Results One hundred forty consecutive patients were r and omized . A similar proportion of patients returned for study follow-up in both groups at 3 months ( 54 [79%]/68 in the usual care group vs 57 [79%]/72 in the intervention group ; P = 0.97 ) . Among those completing the 3-month visit , a low-density lipoprotein cholesterol level less than 100 mg/dL was achieved in 37 ( 69 % ) of the usual care patients compared with 35 ( 57 % ) of those in the intervention group ( P = 0.43 ) . There was no statistical difference in implementation of therapeutic lifestyle changes ( smoking cessation , cardiac rehabilitation , or exercise ) between groups . Prescription rates of evidence -based therapeutics at 3 months were similar in both groups . Conclusion The implementation of a post-ACS clinic run by a physician extender applying a disease management algorithm did not measurably improve adherence to evidence -based secondary prevention treatment goals . Despite initially high rates of evidence -based treatment at discharge , adherence with follow-up appointments and sustained implementation of evidence -based therapies remains a significant challenge in this high-risk cohort
Conclusions Organisational and professional interventions improved prescribing of statins/lipid-lowering agents and target blood pressure in patients with IHDs but there was little evidence of change in other outcomes .
Objectives Ischaemic heart diseases ( IHDs ) are a leading cause of death worldwide .
Although prescribing according to guidelines improves health outcomes , it remains suboptimal .
We determined whether interventions targeted at healthcare professionals are effective to enhance prescribing and health outcomes in patients with IHDs .