Quality improvement report - A laboratory based intervention to improve appropriateness of lipid tests and audit cholesterol lowering in primary care

Problem A need exists to reduce inequalities in lipid testing, to provide r elevant, individual, patient based interpretation for users, and to audit l ipid lowering in primary care. Design Model to compare laboratory activity between different general pract ices; construction of computer based strategies to define the lipid tests t o be done and to interpret result, few primary and secondary coronary preve ntion patients; introduction of the strategies into routine use; monitoring of any change after the intervention; and investigation of the potential e f the strategies to produce audit dam for primary care groups. Background and setting Hospital clinical laboratory serving 22 general prac tices covering 150 000 patients in Bishop Auckland area County Durham. Key measurements for improvement Reduction in differences in testing fee th e different serum lipids in coronary prevention. Production of usable audit data fore the primary care groups involved. Strategies for change Four different categories of coronary prevention pati ent, with, few each category, the defined lipid tests to be done and advice to be given (based on the results), using the computer based strategies. Effects of change Standardised test activity and the qualitative profile of the tests performed changed significantly. The strategies were readily ado pted (median use 78%) within six months of introduction. Lessons learnt Computer ba led strategies earl correct qualitative and quan titative differences in test requesting, provide interpretative guidance in accordance with national guidelines, and offer a cost effective model to m onitor results of cholesterol lowering in general practice.