ASSISTED DETAILING TO IMPROVE GUIDELINE ADHERENCE

Washington University, Saint Louis MO

Investigators

Abstract

The proposed research builds upon previous work (RO1HL70790 Assisted Detailing to Improve Guideline Adherence) which sought to determine whether physician-targeted, technology-assisted, pharmacist- mediated academic detailing can improve physician adherence to American College of Cardiology/American Heart Association (ACC/AHA) Coronary Heart Disease (CHD) secondary prevention prescribing guidelines and National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) cholesterol-lowering prescribing guidelines in hospitalized patients. This research showed that this intervention does have a significant impact on adherence to prescribing guidelines for patients with established CHD and for patients with diabetes in both a university hospital and a community hospital setting. The current proposal takes the next logical step to determine whether pharmacist-mediated interventions can improve persistence of these interventions beyond the point of hospital discharge. The long-term objective is to develop a generalizable model for implementing guidelines, bridging the gap between inpatient and outpatient care using the Chronic Care Model as the organizing framework. The specific objective of this research is to assess whether the proposed intervention will improve patient adherence to NCEP ATP III cholesterol-lowering medication guidelines for patients with established CHD and patients with CHD equivalent conditions. The study employs a randomized, controlled design comparing existing practice to a technology-assisted, pharmacist- mediated patient- centered intervention. It employs technology to to identify candidates for intervention and to track their adherence. MO HealthNet (Missouri Medicaid) patients admitted to a large Midwestern teaching facility who are candidates for statin lipid lowering therapy will be enrolled, and their adherence to statins will be studied following hospital discharge. The primary outcome measure is patient adherence to statins following hospital discharge. We expect to determine the effectiveness and feasibility of technology-assisted, pharmacist-mediated patient-centered interventions for this important patient population.