An Educational Intervention to Improve Statin Use: Cluster RCT at the Primary Care Level in Argentina

Pablo E Gulayin; Alfredo Lozada; Andrea Beratarrechea; Laura Gutierrez; Rosana Poggio; Raúl Martín Chaparro; Marilina Santero; Walter Masson; Adolfo Rubinstein; Vilma Irazola

doi:10.1016/j.amepre.2019.02.018

An Educational Intervention to Improve Statin Use: Cluster RCT at the Primary Care Level in Argentina

Am J Prev Med. 2019 Jul;57(1):95-105. doi: 10.1016/j.amepre.2019.02.018. Epub 2019 May 23.

Affiliations

¹ Institute for Clinical Effectiveness and Health Policy, Research in Chronic Diseases Department, Buenos Aires, Argentina. Electronic address: pgulayin@iecs.org.ar.
² Lipid Clinic at Austral University, Pilar, Argentina.
³ Institute for Clinical Effectiveness and Health Policy, Research in Chronic Diseases Department, Buenos Aires, Argentina.
⁴ Buenos Aires Italiano Hospital, Ciudad Autónoma de Buenos Aires, Argentina.
⁵ National Ministry of Health, Buenos Aires, Argentina.

PMID: 31128958
DOI: 10.1016/j.amepre.2019.02.018

Abstract

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.

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Argentina
Cholesterol, LDL / blood*
Developing Countries
Female
Guidelines as Topic / standards
Humans
Hydroxymethylglutaryl-CoA Reductase Inhibitors / therapeutic use*
Hypercholesterolemia / blood
Hypercholesterolemia / drug therapy*
Male
Middle Aged
Mobile Applications / trends
Physicians, Primary Care / education*
Risk Factors
Telemedicine / trends*

Substances

Cholesterol, LDL
Hydroxymethylglutaryl-CoA Reductase Inhibitors

Associated data

ClinicalTrials.gov/NCT02380911