(Ivanhoe Newswire) – An innovative program cut cardiac deaths by 73
percent by linking coronary artery disease patients to full-spectrum teams
of care givers with an electronic health record (EHR), according to a new
study by Kaiser Permanente. This is the first randomized study to evaluate a
follow-up system for patients discharged from a cardiovascular risk
reduction service, researchers said.
The Clinical Pharmacy Cardiac Risk Service at Kaiser Permanente Colorado
combines the electronic health record with proactive patient outreach and
effective medication management. The two-year randomized trial of 421
patients found patients discharged from the program kept their lipid and
blood pressure levels at controlled, healthy levels by receiving electronic
reminder letters.
The effectiveness of EHR intervention at keeping cholesterol and blood
pressure in check was equal to that of the more intensive counseling
approach received by those patients who remained enrolled in the program.
"Because lack of adherence to medications and failure to maintain treatment
goals are so high among heart disease patients, we wanted to find out what
would happen to the patients after they were discharged from the program but
remained in contact with the health care system through our electronic
health record," study lead author, Kari L. Olson, a Clinical Pharmacy
Specialist with Kaiser Permanente Colorado's Cardiac Risk Reduction program
was quoted as saying. "The takeaway message here is that we can help support
patients in maintaining treatment goals and medication adherence, which is
often a challenge with most chronic conditions. Using technology and
integrated systems already in place, we can help keep patients healthy for
longer and deliver continuity of care in a cost efficient manner."
In the study, 421 patients in the Clinical Pharmacy Cardiac Risk Service
with well-controlled blood pressure and cholesterol levels were randomized
so that 214 continued in the program to receive intensive direct counseling
from the care team. The other 207 patients were discharged from the program
back to their primary care physicians. The mean age of the trial
participants was 72 years old, and 74 percent were male.
The patients who were discharged from the program had electronic reminders
in their charts to ensure their lipid panels were ordered annually, with the
results sent directly to their primary care physicians. The discharged
patients also received reminder letters informing them when they were due
for lab tests.
The study found that patients discharged from the program maintained control
of their risk factors with the help of electronic reminder letters.
The program also achieved these previous reported results:
• Patients have an 88 percent reduced risk of dying of a cardiac-related
cause when enrolled within 90 days of a heart attack, compared to those not
in the program.
• The number of patients meeting their cholesterol goals went from 26
percent to 73 percent
• The number of patients screened for cholesterol went from 55 percent to 97
percent.
The coordinated, evidence-based care, enabled by an electronic care registry
increased the survival rate dramatically among patients enrolled in the
service. It is estimated more than 135 deaths and 260 costly emergency
interventions were prevented annually as a result of improved care.
SOURCE: The American Journal of Managed Care, August, 2009
