There was mixed evidence that provider-level computerized decision support improves outcomes .
There was more evidence in support of patient-level tools that provide connectivity to the healthcare system , as well as system-level interventions that involve data base monitoring and outreach by central ized care teams .
R and omized controlled trials show wide variability in the effects of HIT on lipid management outcomes .
Evidence suggests that multilevel HIT approaches that target not only providers but include patients and systems approaches will be needed to improve lipid treatment , adherence and quality
BACKGROUND Large gaps in lipid treatment and medication adherence persist in high-risk out patients in the United States .
Health information technology ( HIT ) is being applied to close quality gaps in chronic illness care , but its utility for lipid management has not been widely studied .
OBJECTIVE To perform a qualitative review of the impact of HIT interventions on lipid management processes of care ( screening or testing ; drug initiation , titration or adherence ; or referrals ) or clinical outcomes ( percent at low density lipoprotein cholesterol goal ; absolute lipid levels ; absolute risk scores ; or cardiac hospitalizations ) in out patients with coronary heart disease or at increased risk .
Automated outreach to increase primary adherence to cholesterol-lowering medications.
BACKGROUND Primary nonadherence occurs when new prescriptions are not dispensed . Little is known about how to reduce primary nonadherence . We performed a r and omized controlled trial to evaluate an automated system to decrease primary nonadherence to statins for lowering cholesterol . METHODS Adult members of Kaiser Permanente Southern California with no history of statin use within the past year who did not fill a statin prescription after 1 to 2 weeks were passively enrolled . The intervention group received automated telephone calls followed 1 week later by letters for continued nonadherence ; the control group received no outreach . The primary outcome was a statin dispensed up to 2 weeks after delivery of the letter . Secondary outcomes included refills at intervals up to 1 year . Intervention effectiveness was determined by intent-to-treat analysis and Fisher exact test . Subgroups were examined using logistic regression . RESULTS There were 2606 participants in the intervention group and 2610 in the control group .  Statins were dispensed to 42.3 % of intervention participants and 26.0 % of control participants ( absolute difference , 16.3 % ; P < .001 ) . The relative risk for the intervention vs control group was 1.63 ( 95 % CI , 1.50 - 1.76 ) . Intervention effectiveness varied slightly by age ( P = .045 ) but was effective across all age strata . Differences in the frequency of statin dispensations persisted up to 1 year ( P < .001 ) . CONCLUSIONS The intervention was effective in reducing primary nonadherence to statin medications . Because of low marginal costs for outreach , this strategy appears feasible for reducing primary nonadherence . This approach may generalize well to other medications and chronic conditions
There was mixed evidence that provider-level computerized decision support improves outcomes .
There was more evidence in support of patient-level tools that provide connectivity to the healthcare system , as well as system-level interventions that involve data base monitoring and outreach by central ized care teams .
R and omized controlled trials show wide variability in the effects of HIT on lipid management outcomes .
Evidence suggests that multilevel HIT approaches that target not only providers but include patients and systems approaches will be needed to improve lipid treatment , adherence and quality
BACKGROUND Large gaps in lipid treatment and medication adherence persist in high-risk out patients in the United States .
Health information technology ( HIT ) is being applied to close quality gaps in chronic illness care , but its utility for lipid management has not been widely studied .
OBJECTIVE To perform a qualitative review of the impact of HIT interventions on lipid management processes of care ( screening or testing ; drug initiation , titration or adherence ; or referrals ) or clinical outcomes ( percent at low density lipoprotein cholesterol goal ; absolute lipid levels ; absolute risk scores ; or cardiac hospitalizations ) in out patients with coronary heart disease or at increased risk .