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

• Published in: American journal of preventive medicine Vol. 57; no. 1; pp. 95 - 105
• Main Authors: Gulayin, Pablo E., Lozada, Alfredo, Beratarrechea, Andrea, Gutierrez, Laura, Poggio, Rosana, Chaparro, Raúl Martín, Santero, Marilina, Masson, Walter, Rubinstein, Adolfo, Irazola, Vilma
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Inc 01.07.2019; Elsevier Science Ltd
• Subjects: Cardiovascular diseases; Cholesterol; Clinical medicine; Clinical practice guidelines; Control groups; Density; Educational programs; Evidence-based medicine; Health promotion; Hypercholesterolemia; Intervention; Physicians; Primary care; Risk management; Risk reduction; Statins; Argentina
• ISSN: 0749-3797; 1873-2607
• DOI: 10.1016/j.amepre.2019.02.018

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. Cluster RCT. Ten primary care centers from the public healthcare system of Argentina. 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. 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. 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. 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. This study is registered at www.clinicaltrials.gov NCT02380911.