Cardiac Deaths of Seniors with Artery Disease Cut 73
Percent by Better Communications
Electronic health records, communications play key
role in keeping patients healthy two years after leaving program
August 7, 2009 - An innovative program involving
mostly male senior citizens cut cardiac deaths by 73 percent by linking
coronary artery disease patients and teams of pharmacists, nurses,
primary care doctors, and cardiologists with an electronic health
record. The program also kept the patients healthy two years after they
left the program by keeping them in touch with their care givers
electronically, according to a study by Kaiser Permanente.
Published in The American Journal of Managed
Care this month, this is the first randomized study to evaluate a
follow-up system for patients discharged from a cardiovascular risk
reduction service, researchers said.
The Clinical Pharmacy Cardiac Risk Service at
Kaiser Permanente Colorado combines Kaiser Permanente's industry-leading
electronic health record, Kaiser Permanente HealthConnect, with
proactive patient outreach, education, lifestyle adjustments, and
effective medication management.
The two-year randomized trial of 421 patients found
that patients discharged from the program kept their lipid and blood
pressure levels at controlled, healthy levels by receiving electronic
reminder letters.
"Because lack of adherence to medications and
failure to maintain treatment goals are so high among heart disease
patients, we wanted to find out what would happen to the patients after
they were discharged from the program but remained in contact with the
health care system through our electronic health record," said the
study's lead author, Kari L. Olson, a Clinical Pharmacy Specialist with
Kaiser Permanente Colorado's Cardiac Risk Reduction program.
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"The takeaway message here is that we can help
support patients in maintaining treatment goals and medication
adherence, which is often a challenge with most chronic conditions.
Using technology and integrated systems already in place, we can help
keep patients healthy for longer and deliver continuity of care in a
cost efficient manner."
In the study, 421 patients in the Clinical Pharmacy
Cardiac Risk Service with well-controlled blood pressure and cholesterol
levels were randomized so that 214 continued in the program to receive
intensive direct counseling from the care team.
The other 207 patients were discharged from the
program back to their primary care physician.
The mean age of the trial participants was 72 years
old, and 74 percent were male.
The patients who were discharged from the program
had electronic reminders in their chart to ensure their lipid panels
were ordered annually, with the results sent directly to their primary
care physician.
The discharged patients also received reminder
letters generated by KP HealthConnect indicating they were due for a lab
test. Importantly, the study found that patients discharged from the
program maintained control of their risk factors with the help of
electronic reminder letters.
The EHR intervention was as effective at keeping
cholesterol and blood pressure in check, compared to the more intensive
counseling approach offered to those patients who stayed enrolled in the
program.
The Clinical Pharmacy Cardiac Risk Service cares
for 13,000 cardiac patients with integrated nursing and pharmacy teams
that work collaboratively with patients and their doctors using
technology tools and activities such as lifestyle modification,
medication management, patient education, laboratory results monitoring,
and management of adverse events.
The program also achieved these previous reported
results:
● Patients have an 88 percent reduced risk of
dying of a cardiac-related cause when enrolled within 90 days of a heart
attack, compared to those not in the program;
● The number of patients meeting their
cholesterol goal went from 26 percent to 73 percent, and;
● The number of patients screened for cholesterol
went from 55 percent to 97 percent.
The coordinated, evidence-based care, enabled by KP
HealthConnect and an electronic care registry, increased the survival
rate dramatically among patients enrolled in the service.
It is estimated that more than 135 deaths and 260
costly emergency interventions were prevented annually as a result of
improved care. Now, the latest study results suggest that once the
program has helped get risk factors under control, patients can then be
discharged and followed virtually with the same success.
The study was funded by the American College of
Clinical Pharmacy.
Other authors on this study include: Thomas Delate,
PhD; Jon Rasmussen, PharmD; Tammy L. Humphries, PharmD; and John A.
Merenich, MD; for the Kaiser Permanente Colorado Clinical Pharmacy
Cardiac Risk Service Study Group.
About Kaiser Permanente
Kaiser Permanente says it is committed to helping
shape the future of health care. “We are recognized as one of America's
leading health care providers and not-for-profit health plans. Founded
in 1945, our mission is to provide high-quality, affordable health care
services to improve the health of our members and the communities we
serve. We currently serve 8.6 million members in nine states and the
District of Columbia. Care for members and patients is focused on their
total health and guided by their personal physicians, specialists and
team of caregivers.” For more information, go to:
www.kp.org/newscenter.
