Electronic Follow-Up Helps Cardiac Patients
Reported August 11, 2009
(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