Introduction
Statins are essential drugs for high cardiovascular disease (CVD) risk management;
however, there is still low adherence to good clinical practice guidelines for statin
use at the primary care level in low- and middle-income countries. This study aimed
to test whether a complex intervention targeting physicians improves treatment and
control of hypercholesterolemia among patients with moderate to high CVD risk in Argentina.
Study design
Cluster RCT.
Setting/participants
Ten primary care centers from the public healthcare system of Argentina.
Intervention
Primary care physicians in the intervention group received an educational program
with three main components: (1) an intensive 2-day training workshop; (2) educational
outreach visits; and (3) a mobile health application installed on the physician's
smartphones.
Main outcome measures
Reduction in mean low-density lipoprotein cholesterol level, reduction in mean Framingham
risk score, proportion of patients receiving an appropriate statin dose, and mean
annual number of primary care center visits.
Results
Data were analyzed in 2017–2018. Between April 2015 and April 2016, a total of 357
participants were enrolled (179 patients in the intervention group and 178 in the
control group). The global follow-up rate was 97.2%. At the end of the follow-up period,
there was no difference in low-density lipoprotein cholesterol levels in any of the
follow-up points among the groups. Mean CVD risk had a significant net difference
in the first 6 months in the intervention group versus the control group (–4.0, 95%
CI = –6.5, –1.5). At the end of follow-up, there was an absolute 41.5% higher rate
of participants receiving an appropriate statin dose in the intervention group versus
the control group.
Conclusions
Although the intervention did not reach a reduction in cholesterol levels, it had
a significant positive impact on the promotion of adequate use of clinical practice
guidelines.
Trial registration
This study is registered at www.clinicaltrials.gov NCT02380911.
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Article Info
Publication History
Published online: May 23, 2019
Identification
Copyright
© 2019 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.
