• Pablo E Gulayin, Alfredo Lozada, Andrea Beratarrechea, Laura Gutierrez, Rosana Poggio, Raúl Martín Chaparro, Marilina Santero, Walter Masson, Adolfo Rubinstein, and Vilma Irazola.
• Institute for Clinical Effectiveness and Health Policy, Research in Chronic Diseases Department, Buenos Aires, Argentina. Electronic address: pgulayin@iecs.org.ar.
• Am J Prev Med. 2019 Jul 1; 57 (1): 95-105.

IntroductionStatins 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 DesignCluster RCT.Setting/ParticipantsTen primary care centers from the public healthcare system of Argentina.InterventionPrimary 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 MeasuresReduction 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.ResultsData 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.ConclusionsAlthough 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 RegistrationThis study is registered at www.clinicaltrials.gov NCT02380911.Copyright © 2019 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

23 keywords...

hide…