Advertisement

Case-based educational intervention to assess change in providers' knowledge and attitudes towards the 2013 American College of Cardiology/American Heart Association Cholesterol Management Guideline

  • Author Footnotes
    1 Present address: Saint Luke's Mid-America Heart Institute, University of Missouri–Kansas City, 4401 Wornall Road, SLNI, CV Research 5th Floor, Kansas City, MO 64111, USA.
    Yashashwi Pokharel
    Footnotes
    1 Present address: Saint Luke's Mid-America Heart Institute, University of Missouri–Kansas City, 4401 Wornall Road, SLNI, CV Research 5th Floor, Kansas City, MO 64111, USA.
    Affiliations
    Sections of Cardiovascular Research, Baylor College of Medicine, Houston, TX, USA

    Department of Medicine, Baylor College of Medicine, Houston, TX, USA

    Center for Cardiovascular Disease Prevention, Methodist DeBakey Heart and Vascular Center, Houston, TX, USA
    Search for articles by this author
  • Lynne Steinberg
    Affiliations
    Department of Psychology, University of Houston, Houston, TX, USA
    Search for articles by this author
  • Winston Chan
    Affiliations
    Department of Medicine, Baylor College of Medicine, Houston, TX, USA

    Health Policy, Quality & Informatics Program, Michael E. DeBakey VA Medical Center Health Services Research & Development Center for Innovations, Houston, TX, USA
    Search for articles by this author
  • Julia M. Akeroyd
    Affiliations
    Department of Medicine, Baylor College of Medicine, Houston, TX, USA

    Health Policy, Quality & Informatics Program, Michael E. DeBakey VA Medical Center Health Services Research & Development Center for Innovations, Houston, TX, USA
    Search for articles by this author
  • Peter H. Jones
    Affiliations
    Sections of Cardiovascular Research, Baylor College of Medicine, Houston, TX, USA

    Department of Medicine, Baylor College of Medicine, Houston, TX, USA

    Center for Cardiovascular Disease Prevention, Methodist DeBakey Heart and Vascular Center, Houston, TX, USA
    Search for articles by this author
  • Vijay Nambi
    Affiliations
    Sections of Cardiovascular Research, Baylor College of Medicine, Houston, TX, USA

    Department of Medicine, Baylor College of Medicine, Houston, TX, USA

    Center for Cardiovascular Disease Prevention, Methodist DeBakey Heart and Vascular Center, Houston, TX, USA

    Michael E. DeBakey VA Medical Center, Houston, TX, USA
    Search for articles by this author
  • Khurram Nasir
    Affiliations
    Center for Prevention and Wellness Research, Baptist Health Medical Group, Miami Beach, FL, USA
    Search for articles by this author
  • Laura Petersen
    Affiliations
    Department of Medicine, Baylor College of Medicine, Houston, TX, USA

    Health Policy, Quality & Informatics Program, Michael E. DeBakey VA Medical Center Health Services Research & Development Center for Innovations, Houston, TX, USA
    Search for articles by this author
  • Christie M. Ballantyne
    Affiliations
    Sections of Cardiovascular Research, Baylor College of Medicine, Houston, TX, USA

    Department of Medicine, Baylor College of Medicine, Houston, TX, USA

    Center for Cardiovascular Disease Prevention, Methodist DeBakey Heart and Vascular Center, Houston, TX, USA
    Search for articles by this author
  • Salim S. Virani
    Correspondence
    Corresponding author. Health Services Research and Development (152), Michael E. DeBakey Veterans Affairs Medical Center, 2002 Holcombe Blvd., Houston, TX, 77030, USA.
    Affiliations
    Sections of Cardiovascular Research, Baylor College of Medicine, Houston, TX, USA

    Department of Medicine, Baylor College of Medicine, Houston, TX, USA

    Center for Cardiovascular Disease Prevention, Methodist DeBakey Heart and Vascular Center, Houston, TX, USA

    Health Policy, Quality & Informatics Program, Michael E. DeBakey VA Medical Center Health Services Research & Development Center for Innovations, Houston, TX, USA

    Michael E. DeBakey VA Medical Center, Houston, TX, USA
    Search for articles by this author
  • Author Footnotes
    1 Present address: Saint Luke's Mid-America Heart Institute, University of Missouri–Kansas City, 4401 Wornall Road, SLNI, CV Research 5th Floor, Kansas City, MO 64111, USA.

      Highlights

      • 2013 ACC/AHA cholesterol guideline was controversial and had sub-optimal adherence.
      • We offered case based educational intervention to assess improvement in provider-level knowledge gaps.
      • The intervention was associated with 16–53% absolute improvement in knowledge domain.
      • There was 4–36% improvement in attitude domain.
      • An engaging case based intervention can help in effective dissemination of the cholesterol guideline.

      Abstract

      Objective

      Prior studies have shown provider-level knowledge gaps regarding the 2013 American College of Cardiology/American Heart Association guideline on the treatment of cholesterol and concerns about 10-year atherosclerotic cardiovascular disease (ASCVD) risk estimation. The effect of an educational intervention to mitigate knowledge gaps is unknown.

      Methods

      We developed a questionnaire and administered it to providers before (pre-training) and after (post-training) a case-based educational intervention across 6 sites in Texas. The intervention highlighted the key recommendations of the 2013 guideline and the differences from the prior guideline mainly using clinical-vignettes. Several practice pertinent items were also discussed.

      Results

      Most participants were providers-in-training (78%) in internal medicine (68%). Compared to pre-training, the post-training metrics were: 43% vs. 82% for providers' ability to identify 4 statin benefit groups; 47% vs. 97% for their awareness of the ASCVD risk threshold of ≥7.5% to initiate discussion about risks/benefits of statin therapy; 9% vs. 40% for awareness of differences between the Framingham and the ASCVD risk estimator; 26% vs. 78% for awareness of the definition of statin intensity; 35% vs. 62% for using a repeat lipid panel to document treatment response and adherence; and 46% vs. 81% for confidence in using the ASCVD risk estimator, respectively.

      Conclusions

      A case-based educational intervention was associated with significant increase in providers' knowledge towards the 2013 cholesterol guideline, which could be related to the engaging nature of our intervention, using practice pertinent information and clinical vignettes. Such interventions could be useful in effective dissemination of the cholesterol guideline.

      Keywords

      Abbreviations:

      ACC/AHA (American College of Cardiology/American Heart Association), ASCVD (atherosclerotic cardiovascular disease), ATP-III (adult treatment panel III), CHD (coronary heart disease), FH (familial hypercholesterolemia), LDL-C (low-density lipoprotein cholesterol), MI (myocardial infarction)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Atherosclerosis
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Stone N.J.
        • Robinson J.G.
        • Lichtenstein A.H.
        • et al.
        2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American College of Cardiology/American Heart association task force on practice guidelines.
        Circulation. 2014; 129: S1-S45
      1. Executive summary of the third report of the national cholesterol education program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (adult treatment panel III).
        JAMA. 2001; 285: 2486-2497
        • Ridker P.M.
        • Cook N.R.
        Statins: new American guidelines for prevention of cardiovascular disease.
        Lancet. 2013; 382: 1762-1765
        • Pencina M.J.
        • Navar-Boggan A.M.
        • D'Agostino Sr., R.B.
        • et al.
        Application of new cholesterol guidelines to a population-based sample.
        N. Engl. J. Med. 2014; 370: 1422-1431
        • Yeboah J.
        • Sillau S.
        • Delaney J.C.
        • et al.
        Implications of the new American College of Cardiology/American Heart Association cholesterol guidelines for primary atherosclerotic cardiovascular disease event prevention in a multi ethnic cohort: multi-ethnic study of atherosclerosis (MESA).
        Am. Heart J. 2015; 169 (387–395 e383)
        • Martin S.S.
        • Abd T.T.
        • Jones S.R.
        • Michos E.D.
        • Blumenthal R.S.
        • Blaha M.J.
        2013 ACC/AHA cholesterol treatment guideline: what was done well and what could be done better.
        J. Am. Coll. Cardiol. 2014; 63: 2674-2678
        • Maddox T.M.
        • Borden W.B.
        • Tang F.
        • et al.
        Implications of the 2013 ACC/AHA cholesterol guidelines for adults in contemporary cardiovascular practice: insights from the NCDR PINNACLE registry.
        J. Am. Coll. Cardiol. 2014; 64: 2183-2192
        • Virani S.S.
        • Woodard L.D.
        • Ramsey D.J.
        • et al.
        Gender disparities in evidence-based statin therapy in patients with cardiovascular disease.
        Am. J. Cardiol. 2015; 115: 21-26
      2. Y. Pokharel, R. Hira, V. Nambi, T. Shah, L. Woodard, J. Akeroyd, D. Winchester, D. Ramsey, C. Ballantyne, L. Petersen, S. Virani, Statin use and its Facility-Level Variation in a National Sample of Diabetic Patients, Diabetes. 64 (Suppl. 1) (A101–A187):691-P.

        • Jame S.
        • Wittenberg E.
        • Potter M.B.
        • Fleischmann K.E.
        The new lipid guidelines: what do primary care clinicians think?.
        Am. J. Med. 2015; 128 (914 e915–914 e910)
      3. S.S. Virani, Y. Pokharel, L. Steinberg, et al., Provider Understanding of the 2013 ACC/AHA Cholesterol Guideline, J. Clin. Lipidol. doi:http://dx.doi.org/10.1016/j.jacl.2015.1011.1002.

        • Cabana M.D.
        • Rand C.S.
        • Powe N.R.
        • et al.
        Why don't physicians follow clinical practice guidelines? A framework for improvement.
        JAMA. 1999; 282: 1458-1465
        • Virani S.S.
        • Steinberg L.
        • Murray T.
        • et al.
        Barriers to non-HDL cholesterol goal attainment by providers.
        Am. J. Med. 2011; 124 (876–880 e872)
        • Negi S.I.
        • Steinberg L.
        • Polsani V.R.
        • et al.
        Non-high-density lipoprotein cholesterol calculation and goal awareness among physicians-in-training.
        J. Clin. Lipidol. 2012; 6: 50-57
        • Benjamini Y.
        • Hochberg Y.
        Controlling the false discovery rate: a practical and powerful approach to multiple testing.
        J. R. Stat. Soc. Ser. B Methodol. 1995; 57: 2289-2300
        • Akbari A.
        • Mayhew A.
        • Al-Alawi M.A.
        • et al.
        Interventions to improve outpatient referrals from primary care to secondary care.
        Cochrane Database Syst. Rev. 2008; 4: CD005471
        • Forsetlund L.
        • Bjorndal A.
        • Rashidian A.
        • et al.
        Continuing education meetings and workshops: effects on professional practice and health care outcomes.
        Cochrane Database Syst. Rev. 2009; 2: CD003030
        • O'Brien M.A.
        • Rogers S.
        • Jamtvedt G.
        • et al.
        Educational outreach visits: effects on professional practice and health care outcomes.
        Cochrane Database Syst. Rev. 2007; 4: CD000409
        • Grol R.
        Improving Patient Care the Implementation of Change in Health Care.
        second ed. John Wiley & Sons, Somerset, NJ, USA2013
        • Bloom B.S.
        Effects of continuing medical education on improving physician clinical care and patient health: a review of systematic reviews.
        Int. J. Technol. Assess. Health Care. 2005; 21: 380-385
        • Marinopoulos S.S.
        • Dorman T.
        • Ratanawongsa N.
        • et al.
        Effectiveness of continuing medical education.
        Evid. Rep. Technol. Assess. Full Rep. 2007; 149: 1-69
        • Zwarenstein M.
        • Hux J.E.
        • Kelsall D.
        • et al.
        The Ontario printed educational message (OPEM) trial to narrow the evidence-practice gap with respect to prescribing practices of general and family physicians: a cluster randomized controlled trial, targeting the care of individuals with diabetes and hypertension in Ontario, Canada.
        Implement Sci. 2007; 2: 37
        • Fordis M.
        • King J.E.
        • Ballantyne C.M.
        • et al.
        Comparison of the instructional efficacy of Internet-based CME with live interactive CME workshops: a randomized controlled trial.
        JAMA. 2005; 294: 1043-1051