EFFECTS OF PRACTICE SETTING ON QUALITY OF LIPID-LOWERING MANAGEMENT IN PATIENTS WITH CORONARY-ARTERY DISEASE

We undertook a study to determine whether there were differences in th e quality of lipid management in patients with coronary artery disease (CAD) in 2 different practice settings (which represent different soc ioeconomic classes), and to determine the level of compliance with the National Cholesterol Education Program guidelines by academic physici ans in managing patients with CAD. A retrospective cross-sectional stu dy was performed using a systematic chart review of 270 medical record s (131 from the cardiology clinic, 139 from the cardiology private pra ctice) of patients with known CAD at an academic tertiary care center in New York City. The total proportion of patients with CAD having a l ipid profile ordered in the clinic and private suite was 43%. Of these people, 22% had a low-density lipoprotein cholesterol (LDL) less than or equal to 100 mg/dl and 54% had an LDL less than or equal to 130 mg /dl (10% and 23% of the total population, respectively). The total pro portion of patients taking lipid-lowering medications was 29%. When co mparing the quality of treatment between the 2 settings, there were no statistically significant differences in the percentages of patients who had lipid profiles measured (40% clinic vs 47% private suite, p>0. 10), in the percentage of patients with LDL less than or equal to 130 mg/dl (50% clinic vs 57% private suite, p>0.10) or in the weighted per centage of patients taking lipid-lowering medications (29% clinic vs 4 8% private suite, p = 0.099). The performances of individual physician s, however, varied widely. The percentages of patients with lipid prof iles measured by individual physicians ranged from 0% to 83%, while th e percentages of patients on drug treatment by a physician ranged betw een 10% and 88%. These findings indicate that socioeconomic difference s, represented by different practice settings, do not account for diff erences in the screening for, control of, or use of medications in man aging hyperlipidemia. Rather, individual physicians are accountable fo r differences in lipid management. (C) 1998 by Excerpta Medica, Inc.