The study aimed to determine if group appointments called PHASE improved statin adherence and LDL outcomes, and if effects differed by ethnicity. Retrospectively, 60 patients were divided into those who did (PHASE, n=30) or did not (non-PHASE, n=30) attend PHASE. No significant differences were found between groups in LDL or adherence over 6 months. However, PHASE patients were more likely to have labs done and remain on statins long-term. Secondary analysis found some interethnic differences in adherence and LDL within groups over time.
Erectile Dysfunction and Risk Factors in Male Peruvian Hemodialysis Patientsasclepiuspdfs
Introduction: Erectile dysfunction (ED) is a common condition in patients with renal disease, but little is known about the prevalence of ED in some specific groups of patients such as Peruvian hemodialysis (HD) patients. Materials and Methods: A cross‑sectional study was conducted to determine the frequency of ED in HD patients (n = 390) in Lima, Peru. The prevalence and severity of ED were assessed using the International Index of Erectile Function with the validated Peruvian version. The dependence of ED on independent variables was evaluated by logistic regression. P ≤ 0.05 was regarded as statistically significant.
This study uses consecutive National Health and Nutrition Examination Surveys (NHANES) data from 2003-2012 to concurrently model obese body size (c.f., normal weight) main effects, moderated by nondiabetic moderate 10-year ASCVD risk (c.f., 30-year and diabetic), on total medical cost outcomes.
• Minors, seniors 76+, outlier diseases, and pregnant women were excluded, resulting in 192,447,424 weighted or 22,510 unweighted participants.
Update on the evidence to support deprescribing, a presentation by David Erskine, Director – London & South East Medicine Information Service (July 2017).
Erectile Dysfunction and Risk Factors in Male Peruvian Hemodialysis Patientsasclepiuspdfs
Introduction: Erectile dysfunction (ED) is a common condition in patients with renal disease, but little is known about the prevalence of ED in some specific groups of patients such as Peruvian hemodialysis (HD) patients. Materials and Methods: A cross‑sectional study was conducted to determine the frequency of ED in HD patients (n = 390) in Lima, Peru. The prevalence and severity of ED were assessed using the International Index of Erectile Function with the validated Peruvian version. The dependence of ED on independent variables was evaluated by logistic regression. P ≤ 0.05 was regarded as statistically significant.
This study uses consecutive National Health and Nutrition Examination Surveys (NHANES) data from 2003-2012 to concurrently model obese body size (c.f., normal weight) main effects, moderated by nondiabetic moderate 10-year ASCVD risk (c.f., 30-year and diabetic), on total medical cost outcomes.
• Minors, seniors 76+, outlier diseases, and pregnant women were excluded, resulting in 192,447,424 weighted or 22,510 unweighted participants.
Update on the evidence to support deprescribing, a presentation by David Erskine, Director – London & South East Medicine Information Service (July 2017).
The investigation (summarized in the attached slides) analyzed how at-risk obese/overweight patients interact with beneficial interventions (2013 AHA/ACC risk, cholesterol, obesity and lifestyle prevention guidelines). The study estimated the savings potential if overweight/obese patients in the ACC/AHA four statin benefit groups stepped-down one risk level.
Title: Cost Of Obesity-Based Heart Risk In The Context Of Preventive And Managed Care Decision-Making: An NHANES Cross-Sectional Concurrent Study
By: John Frias Morales
Knowledge and Perceptions Related to Hypertension, Lifestyle Behavior Modific...iosrjce
IOSR Journal of Nursing and health Science is ambitious to disseminate information and experience in education, practice and investigation between medicine, nursing and all the sciences involved in health care. Nursing & Health Sciences focuses on the international exchange of knowledge in nursing and health sciences. The journal publishes peer-reviewed papers on original research, education and clinical practice.
By encouraging scholars from around the world to share their knowledge and expertise, the journal aims to provide the reader with a deeper understanding of the lived experience of nursing and health sciences and the opportunity to enrich their own area of practice. The journal publishes original papers, reviews, special and general articles, case management etc.
Geriatric Oncology
1. Relationship between aging and cancer
2. Constructs of frailty and multimorbidity
3. Evidence for geriatric assessment in older adults living with cancer
Predicting Trends in Preventive Care Service Utilization Impacting Cardiovasc...gpartha85
National reports point towards disparities in the utilization of preventive care services but sparse literature exists regarding predicting utilization pattern of preventive care services.
METHODS: The 2007 Medical Expenditure Panel Survey (MEPS), a national probability sample survey of the ambulatory civilian US population, was analyzed to determine demographic patterns of utilization. Recommendations by JNC-VII and NCEP were used to determine guideline adherence to blood pressure and cholesterol checkup respectively. Utilization of blood pressure screening and cholesterol checkup services were used as the dependent variable while age, gender, race, ethnicity, insurance status, perceived health status were used as independent variables. Since guidelines differ for people with elevated blood pressure, respondents with elevated blood pressure were identified in the MEPS database by self-reported diagnosis. Descriptive statistics were used to describe the population, chi-square analysis was used to determine the group differences for the categorical variables. Multivariate logistic regression model was built to predict odds of utilizing appropriate preventive se!
rvices. All analysis was carried out using SAS v9.1.
RESULTS: Total number of adult respondents was 20,434 of which data was available for blood pressure checkup for 20,187 respondents and 15,784 respondents for cholesterol checkup. Overall, respondents were found to adhere to guideline recommendations for getting the blood pressure (n=17,959, 89.0%) and cholesterol (n=14,956, 94.7%) check-up done. A univariate chi-square analysis showed statistically significant differences across all independent variables between people who utilized the preventive care service and those who didn t for blood pressure checkup (p<0><0>65) had much higher odds of using the blood pressure (OR=2.815, CI=2.317-3.420 ) and cholesterol (OR=3.190, CI=2.396-4.!
249 ) preventive services. Males had much lower odds of getting blood pressure (OR=0.350, CI=0.318-0.384) and cholesterol (OR=0.597, CI=0.516-0.692) checks done compared to females. Odds of utilization were nearly similar for all races. Uninsured had lower odds for blood pressure (OR=0.282, CI=0.253-0.315) and cholesterol (OR=0.314, CI=0.262-0.376) use compared to privately insured people.
CONCLUSIONS: Overall MEPS respondents adhered to blood pressure and cholesterol check up guidelines. The study was however successful in identifying existing age, race, income, insurance status related disparities in US population.
Predicting Trends in Preventive Care Service Utilization Impacting Cardiovasc...gpartha85
-To characterize the utilization pattern of preventive care services impacting cardiovascular outcomes in a U.S population using a national database
-To predict the trends in cardiovascular preventive care services in a U.S. population
The investigation (summarized in the attached slides) analyzed how at-risk obese/overweight patients interact with beneficial interventions (2013 AHA/ACC risk, cholesterol, obesity and lifestyle prevention guidelines). The study estimated the savings potential if overweight/obese patients in the ACC/AHA four statin benefit groups stepped-down one risk level.
Title: Cost Of Obesity-Based Heart Risk In The Context Of Preventive And Managed Care Decision-Making: An NHANES Cross-Sectional Concurrent Study
By: John Frias Morales
Knowledge and Perceptions Related to Hypertension, Lifestyle Behavior Modific...iosrjce
IOSR Journal of Nursing and health Science is ambitious to disseminate information and experience in education, practice and investigation between medicine, nursing and all the sciences involved in health care. Nursing & Health Sciences focuses on the international exchange of knowledge in nursing and health sciences. The journal publishes peer-reviewed papers on original research, education and clinical practice.
By encouraging scholars from around the world to share their knowledge and expertise, the journal aims to provide the reader with a deeper understanding of the lived experience of nursing and health sciences and the opportunity to enrich their own area of practice. The journal publishes original papers, reviews, special and general articles, case management etc.
Geriatric Oncology
1. Relationship between aging and cancer
2. Constructs of frailty and multimorbidity
3. Evidence for geriatric assessment in older adults living with cancer
Predicting Trends in Preventive Care Service Utilization Impacting Cardiovasc...gpartha85
National reports point towards disparities in the utilization of preventive care services but sparse literature exists regarding predicting utilization pattern of preventive care services.
METHODS: The 2007 Medical Expenditure Panel Survey (MEPS), a national probability sample survey of the ambulatory civilian US population, was analyzed to determine demographic patterns of utilization. Recommendations by JNC-VII and NCEP were used to determine guideline adherence to blood pressure and cholesterol checkup respectively. Utilization of blood pressure screening and cholesterol checkup services were used as the dependent variable while age, gender, race, ethnicity, insurance status, perceived health status were used as independent variables. Since guidelines differ for people with elevated blood pressure, respondents with elevated blood pressure were identified in the MEPS database by self-reported diagnosis. Descriptive statistics were used to describe the population, chi-square analysis was used to determine the group differences for the categorical variables. Multivariate logistic regression model was built to predict odds of utilizing appropriate preventive se!
rvices. All analysis was carried out using SAS v9.1.
RESULTS: Total number of adult respondents was 20,434 of which data was available for blood pressure checkup for 20,187 respondents and 15,784 respondents for cholesterol checkup. Overall, respondents were found to adhere to guideline recommendations for getting the blood pressure (n=17,959, 89.0%) and cholesterol (n=14,956, 94.7%) check-up done. A univariate chi-square analysis showed statistically significant differences across all independent variables between people who utilized the preventive care service and those who didn t for blood pressure checkup (p<0><0>65) had much higher odds of using the blood pressure (OR=2.815, CI=2.317-3.420 ) and cholesterol (OR=3.190, CI=2.396-4.!
249 ) preventive services. Males had much lower odds of getting blood pressure (OR=0.350, CI=0.318-0.384) and cholesterol (OR=0.597, CI=0.516-0.692) checks done compared to females. Odds of utilization were nearly similar for all races. Uninsured had lower odds for blood pressure (OR=0.282, CI=0.253-0.315) and cholesterol (OR=0.314, CI=0.262-0.376) use compared to privately insured people.
CONCLUSIONS: Overall MEPS respondents adhered to blood pressure and cholesterol check up guidelines. The study was however successful in identifying existing age, race, income, insurance status related disparities in US population.
Predicting Trends in Preventive Care Service Utilization Impacting Cardiovasc...gpartha85
-To characterize the utilization pattern of preventive care services impacting cardiovascular outcomes in a U.S population using a national database
-To predict the trends in cardiovascular preventive care services in a U.S. population
Treatment strategies in patients with statin intoleranceVishwanath Hesarur
Statins are among the most prescribed drugs in the world and are first-line therapy in the management of hyperlipidemia.
Their beneficial effects on cardiovascular morbidity and mortality have been demonstrated both in primary and in secondary prevention.
They are generally safe, but in some patients, statin therapy is stopped because of intolerance to the drug that may result in muscle aches and weakness, gastrointestinal symptoms, liver enzyme abnormalities, or other nonspecific discomforts.
The rate of reported statin-related events is about 5% to 10% in randomized, placebo controlled clinical trials.
STROBE (Strengthening The Reporting of OBservational Studies in Ep.docxsusanschei
STROBE (Strengthening The Reporting of OBservational Studies in Epidemiology) Checklist
Direction: The following is a checklist of items that should be included in reports of observational studies. Use this checklist to evaluate the article by Olotu et al. Give an explanation of whether or not a particular criterion is missing in the article and the page number where a criterion is reported in the article. Do NOT write your name anywhere on the document.
Section and Item
Recommendation
Present?
Explanation
Reported on article
Page #
TITLE AND ABSTRACT
Indicated the study’s design with a commonly used term in the title or the abstract?
☐yes
☐ no
☐n/a
Provided in the abstract an informative and balanced summary of what was done and what was found?
☐yes
☐ no
☐n/a
INTRODUCTION
Background/rationale
Explained the scientific background and rationale for the investigation being reported?
☐yes
☐ no
☐n/a
Objectives
Stated specific objectives, including any pre-specified hypotheses?
☐yes
☐ no
☐n/a
METHODS
Study design
Presented key elements of study design early in the paper?
☐yes
☐ no
☐n/a
ORIGINAL RESEARCH ARTICLE
Use of Statins and the Risk of Incident Diabetes: A Retrospective
Cohort Study
Busuyi S. Olotu1,2,3 • Marvin D. Shepherd2 • Suzanne Novak2,3 • Kenneth A. Lawson2 •
James P. Wilson2 • Kristin M. Richards2 • Rafia S. Rasu1
� Springer International Publishing Switzerland 2016
Abstract
Introduction Even though several landmark statin trials
have demonstrated the beneficial effects of statin therapy
in both primary and secondary prevention of cardiovas-
cular disease, several studies have suggested that statins
are associated with a moderate increase in risk of new-
onset diabetes. These observations prompted the US
FDA to revise statin labels to include a warning of an
increased risk of incident diabetes mellitus as a result of
increases in glycosylated hemoglobin (HbA1c) and fast-
ing plasma glucose. However, few studies have used US-
based data to investigate this statin-associated increased
risk of diabetes.
Objective The primary objective of our study was to
examine whether the use of statins increases the risk of
incident diabetes mellitus using data from the Thomson
Reuters MarketScan
�
Commercial Claims and Encounters
Database.
Method This study was a retrospective cohort analysis
utilizing data for the period 2003–2004. The study popu-
lation included new statin users aged 20–63 years at index
who did not have a history of diabetes.
Results The proportion (3.4 %) of statin users
(N = 53,212) who had incident diabetes was higher
than the proportion (1.2 %) of non-statin users
(N = 53,212) who had incident diabetes. Compared
with no statin use and controlling for demographic and
clinical covariates, statin use was significantly associ-
ated with increased risk of incident diabetes (hazard
ratio 2.01; 99 % confidence interval 1.74–2.33;
p \ 0.0001). In addition, risk of diabetes was highest
amo.
Reducing Stroke Readmissions in Acute Care Setting.docxdanas19
Reducing Stroke Readmissions in Acute Care Setting
Contents
Introduction: 2
Objective of the study: 3
Readmission Factors: 3
Statins: 3
Long term care: 4
Demographics: 4
Personal Reflections: 4
Events: 4
Empirical Evidence: 6
Interventions for discharged patients: 6
TRACS: 7
COMPASS: 7
MISTT: 8
Clinical requirement: 8
Timeline: 8
Collaboration with the preceptor: 8
Proposed evaluative criteria: 9
Evaluative criteria discussed: 9
Conclusion: 9
Bibliography 10
Introduction:
Stroke refers to a cardiovascular disease which has been one of the leading reasons for deaths and long term disability. A stroke is an abrupt onset of a neurological deficit led by a vascular rupture or blockage that reduces the blood flow to brain. Subsequently, causing death to the tissue in the brain region if interruption of the blood flow persists. The indications of stroke vary, but may include the loss of function to one side of the body, the inability to speak or talk, and reduced vision or severe headache (Poston, 2018).
Issue: Discovery Research
Over time, the financial penalties on readmissions to the hospital have been taking place, which is promoting hospitals to take measures to reduce the instance of readmissions. A variety of interventions are taking place on different levels to ensure that pre and post discharge care is in place to avoid readmissions. The efficacy of interventions is dependent on the variety of components. Single component interventions are least effective and tend to have no effect on readmissions to the hospitals. Patients that are discharged to post-acute care accommodations are subjected to multi-component interventions and readmissions have dropped drastically. These interventions work through communication, advanced planning of care, and training to tackle simple medical issues that might cause readmissions. The availability of risk stratification methods have made it easier for the hospitals to give more care and attention to the patients that are more likely to get readmitted. Home based services are provided to ensure proper medical care for the patients.
This capstone project attempts to discuss the factors causing the readmissions of stroke patients to the hospitals. The past 20 years have proven to be important in acute and inpatient stroke care however, quality of post-acute care varies specially for the patients that are discharged to home. (Condon, Lycan, & Duncan, 2016). Different reasons for stroke readmissions are to be examined in this capstone project. Expected Outcomes: Discovery Research
This project aims to take into account the reasons of stroke and readmissions after being treated for stroke. Stroke is the second primary reason of readmissions in the hospital. Major readmissions comprise of elderly people. 20-70% people who survive stroke are readmitted in the first year of their treatment (Bravata, Ho, Meehan, & Brass, 2006). Poor health conditions and high treatment costs both account for the l.
CARDIOVASCULAR DISEASE
CARDIOVASCULAR DISEASE
Cardiovascular Disease
Introduction
Cardiovascular disease posits a major cause of premature deaths and disability throughout the world and contributes to a significant increase in healthcare costs, particularly in medication, healthcare services, and production loss. Specifically, heart diseases and stroke accommodate the highest prevalence rate in the USA; accommodate an average of 610,000 and 365,000 annual deaths from CVD (CDC, 2015). Similarly, every year, CVD causes the USA approximately, $207 billion for medication, healthcare services, and productivity loss. Noteworthy, heart diseases and stroke incidences vary with factors such as ethnicity, gender, age, and individuals with certain disorders. Similarly, the project accommodates notable articulations on intervention, comparison, outcome, and time as a fundamental consideration in heart diseases and stroke in the USA. Thus, an enriched articulation on heart diseases and stroke are underscoring for the project presentation.
Definition
According to (Mayo Clinic, 2018), Heart disease describes a condition that affects the heart; including blood vessels diseases arrhythmias, and other heart defects. Significantly, the heart disease is interchangeable for the CVD, articulating on the infections involving narrowed or blocked blood vessels, causing a heart attack, chest pain, and stroke, among other clinical presentations. Similarly, (Mayo Clinic, 2018) acknowledges that many CVD is preventable and treatable with healthy lifestyle choices.
Epidemiology
Cardiovascular diseases posits an undying cause of death in the USA, projected at 840, 678 deaths in 2016, averagely one in three deaths (Salim et al. 2020). Similarly, between 2013 and 2016 121.5 million adults Americans presented notable for of the CVD. Notably, between 2013 and 2015 direct and indirect costs of managing the CVD in the USA, recorded $213.8 billion and $137.4 billion respectively. Statistically, between 2013 and 2016, 57.1% of non-HN black females and 60.1% of non-HN black males presenting CVD manifestations (Salim et al. 2020). According to the researcher causes of the CVD Include atherosclerosis resulting from an unhealthy diet, lacking exercise, overweight, and smoking. In the epistemology studies, risk factors such as age, sex, family history, smoking, chemotherapy and radiation drugs, high blood pressure, poor diet, obesity, physical inactivity, stress, and poor hygiene are underscoring risk factors in the CVD (Mayo Clinic, 2018). Thus, heart disease epistemological indicates the patterns, causes, risk factors, and specific populations in the USA.
Clinical Presentations
Cardiovascular disease acclaims clinical presentations that may differ between men and women. According to (Mayo Clinic, 2018), men present significant chest pain that women and women clinical presentations such as shortness in breathing, nausea, and fatigue are more evident than in men. Admi ...
International Study of Comparative Health Effectiveness with Medical and Inva...
AE poster
1. • Primary endpoints:
• adherence to statin therapy, assessed at 3 and 6 months from baseline and
defined as picking up a refill of statin medication
• LDL-c outcome as measured from lab tests
• Secondary endpoint: interethnic differences in adherence and outcomes
Cardiovascular disease is a major cause of morbidity and mortality in industrialized
nations, among both men and women [1]. Some conditions known to be major risk factors
for heart attack and stroke are diabetes mellitus, hypertension, and hyperlipidemia.
Bringing blood glucose, blood pressure, and cholesterol levels into recommended
therapeutic goals determined by medical guidelines can cumulatively reduce
cardiovascular risk.
Because of the chronic nature of these risk factors and the suboptimal number (less than
10-20%) of patients reaching goal, multidisciplinary-care teams consisting of physicians,
nurses, case managers, and/or pharmacists have emerged to optimize therapy, patient
follow-up, and patient access to care [3]. Pharmacist-run ambulatory clinics have been
shown to improve outcomes because of pharmacists’ expertise in medication therapy and
adjusting therapeutic regimens. While the current literature contains studies on the effect
of pharmacist-run diabetes clinics, there is need for further studies on lipid and blood
pressure management as these are also major risk factors for cardiovascular events. In
addition, few studies are done with ethnic minority populations, although African
Americans and Latinos have worse outcomes with these risk factors compared to Whites
[3].
HMG CoA-reductase inhibitors (statins) have cardiovascular importance as they have been
shown in many studies to reduce mortality both in CAD and non-CAD patients [1, 4].
However, outcomes and medication adherence differ widely between clinical trials and
actual practice. NCEP ATP III guidelines state that adherence is one of the biggest factors
in successful statin-induced LDL-lowering [1].
Given the benefits of statin medications on cardiovascular health, this study will look at the
effect of a collaborative pharmacist-physician run Preventing Heart Attacks and Strokes
Everyday class on statin adherence and LDL-c outcome. Secondly, we will look at how
these rates may differ between ethnic groups, possibly indicating differences in access or
usage to healthcare services that may be addressed in future studies.
IntroductionIntroduction DiscussionDiscussion
The objectives of this study are to: 1) determine whether group appointments for patients
with CAD or CAD risk factors improve statin adherence and LDL-c outcomes, and 2) if the
changes differ between ethnic class, suggesting greater assistance and outreach needed
for ethnic groups known to experience health disparities.
ObjectiveObjective
Study DesignStudy Design
For the primary endpoints, 9 patients were excluded from the non-PHASE group for statin
pickup at 3 and 6 months because they were not on a statin. In the PHASE arm, 7 patients
were excluded at 3 months and 6 patients at 6 months for statin pickup. One patient from
this arm was started on a statin after the 3-month mark from the date of the PHASE class.
Eliminating patients from statistical analysis for adherence may have made the results less
accurate and resulted in a lack of statistical significance between treatment groups at 3
and 6 months when there may have been one. Ensuring that all patients were on a statin
at the start of the study as an inclusion criterion would have prevented this discrepancy.
The limited number of patients was another limitation in calculating statistical differences
between ethnic classes for statin pickup and LDL outcome. Having small sample sizes may
have made results less accurate; however, the fact that significance was detected between
ethnic groups at 3 months for statin pickup and 6 months for LDL may warrant further
studies to determine factors for these differences. For future studies, it is necessary to
have large sample sizes of the representative population in order to come to reliable
conclusions about any differences.
Strengths of the study:
•Groups were balanced on baseline characteristics
•Generalizable to Santa Clara County based on demographics
•Clinically relevant endpoints
Limitations:
•Small sample size
•Retrospective
•Short duration of study
•Inclusion criteria for being on a statin at beginning of study
ConclusionConclusion
AcknowledgmentsAcknowledgments
Our study did not find significant differences in medication adherence or lab outcomes at
any time point. However, with more patients in each treatment group and longer study
time, more accurate conclusions can be made. When comparing average LDL values
between PHASE and non-PHASE groups, three months showed a p-value of 0.35 while at
six months the p-value was 0.07, possibly indicating that lab differences were beginning to
show between groups as time went on, due to reinforced education and motivation for
those who attended the PHASE class.
In addition, the benefits of cholesterol lowering must be studied over the long term in the
context of preventing major cardiovascular events. According to PHASE management
reports, myocardial infarctions decreased by 42% between 2001-2010, and STEMIs
decreased by 62% for PHASE patients, indicating clinically significant results for ambulatory
care clinics in managing chronic conditions and preventing mortality.
Special thanks to:
•Joyce Watson, PharmD for her guidance and insight throughout this project
•Jeffrey Phan, MD for his encouragement of this study and idea development
•Lawrence Troxell, PharmD for his feedback
•James Scott, PharmD for overseeing this project
•Reggie Villacorta, MA and Tony Dao, PharmD for their invaluable assistance in data analysis
ReferencesReferences
1. Cheng CWR, Woo K, et al. Association between adherence to statin therapy and lipid control in Hong
Kong Chinese patients at high risk of coronary heart disease. Br J Clin Pharmacol. 2004 Nov;58(5):528-
35.
2. Yang CC, Jick SS, Testa MA. Discontinuation and switching of therapy after initiation of lipid-lowering
drugs: the effects of comorbidities and patient characteristics. Br J Clin Pharmacol. 2003 Jul;56(1):84-
91.
3. Gerber BS, Rapacki L, et al. Design of a trial to evaluate the impact of clinical pharmacists and
community health promoters working with African-Americans and Latinos with Diabetes. BMC Public
Health. 2012 Oct 23;12(1):891.
4. Perreault S, Blais L, et al. Persistence and determinants of statin therapy among middle-aged patients
free of cardiovascular disease. Eur J Clin Pharmacol. 2005; 61(9): 667-74.
5. Jennings BT, Marx CM. Implementation of a pharmacist-managed diabetes program. Am J Health Syst
Pharm. 2012 Nov 15;69(22):1951-3.
6. Angel E, Li J. Impact of Spanish Group Appointments on Coronary Artery Disease Prevention for Spanish-
Speaking Patients. 2008
7. Department Goals 2013 Santa Clara Medical Center. Capacity Creation & Membership Growth. 11 Mar
2013.
8. 2011 U.S. Census Bureau
ResultsResults
Table 2: Summary of primary endpoints
Table 1: Baseline characteristics of cohort groups
MethodsMethods
Impact of PHASE Group Appointments on Statin Adherence and LDL-c Outcomes
Caren Nguyen, PharmD candidate; Joyce Watson, PharmD
Western University of Health Sciences College of Pharmacy, Pomona, CA Kaiser Permanente Chronic Conditions Management, Santa Clara, CA
Baseline Characteristics
Non-PHASE group
(N = 30)
PHASE group
(N = 30)
Avg baseline LDL-c 136.1 124.5
Male
Female
15 (50%)
15 (50%)
17 (56.7%)
13 (43.3%)
Age 58.9 62.7
Race
African/African American
Asian/Asian American
Hispanic/Latino
White
Other
2 (6.7%)
9 (30%)
8 (26.7%)
11 (36.7%)
0 (0%)
2 (6.7%)
7 (24.3%)
5 (16.7%)
14 (46.7%)
2 (6.7%)
Spoken language
English 29 (96.7%) 29 (96.7%)
On statin before appointment 18 (60%) 19 (63.3%)
CHD risk factors and risk
equivalents
AAA
Atrial fibrillation
CAD
CHF
CVA/TIA
DM
Hyperlipidemia
HTN
MI
PAD
1
1
3
1
1
24
22
20
2
1
0
4
3
2
2
28
23
26
2
0
Primary Endpoints
Non-PHASE group
(N = 30)
PHASE group
(N = 30)
p-value
Adherence
Statin pickup after 3 mos
Statin pickup after 6 mos
18/21 patients (85.7%)
12/21 patients (57.1%)
23/23 (100%)
16/24 (66.7%)
0.06
0.75
LDL-c after 3 mos
Avg LDL-c
Pts who did lab test
% at goal
93.6
15/30 (50%)
10/15 (66.7%)
93.6
19/30 (63%)
12/19 (63%)
0.35
0.30
0.83
LDL-c after 6 mos
Avg LDL-c
Pts who did lab test
% at goal
113.1
11/30 (36.7%)
5/11 (45.5%)
96.9
21/30 (70%)
12/21 (57.1%)
0.07
0.01
0.24
Avg maximum LDL change -40.75 -31.15 0.20
Pts on statin after appointment 20 (66.7%) 23 (76.7%) 0.04
# CV event after appointment 1 (3.3%) 1 (3.3%) 1
OutcomesOutcomes
Above: summary of inclusion and exclusion
criteria. All patients had CAD risk and were not at
LDL-c goal, so that the effect of the group
appointment on clinical outcome can be
measured.
Left: selection process for study and control
groups.
• Patients to be included in the study were
generated from a list of patients enrolled for a
PHASE group session
• Only sessions from Feb 1, 2012 – Oct 31, 2012
were included
• Patients who did not attend the session
control (non-PHASE) group
• Patients who attended study (PHASE) group
A retrospective chart review:
• Patients in each group were followed for six
months after the date of the PHASE class on
the following parameters:
• LDL-c at 3 months
• Statin pickup at 3 months
• LDL-c at 6 months
• Statin pickup at 6 months
Non-PHASE
Statin pick-up at 3 months
•Difference between ethnic groups (Asian,
AA, Hispanic, White)
p = 0.03
Statin pick-up at 6 months
•Difference between ethnic groups (Asian,
AA, Hispanic, White)
p = 0.19
PHASE
Statin pick-up at 3 months
•Difference between ethnic groups (Asian,
AA, Hispanic, White)
p = 0.24
Statin pick-up at 6 months
•Difference between ethnic groups (Asian,
AA, Hispanic, White)
p = 0.27
Primary endpoints:
One-tailed unpaired t-tests were used to compare numerical data (eg. LDL-c) and chi-
squared tests were used to compare categorical data (eg. statin pickup) between groups.
There was no significant difference between groups on LDL-c values at three months (p =
0.35) or six months (p = 0.07), maximum LDL change from baseline (p = 0.20), or statin
pickup at three months (p = 0.06) or six months (p = 0.75). However, patients who
attended the PHASE class were significantly more likely to have routine lab tests done
over the long term (six months, p = 0.01) and significantly more likely to be on a statin
medication after attending the class (p = 0.04).
Patients excluded from statistical analysis were: those who were not on a statin at three
or six months, and those who did not come in for a lab test at three or six months.
Secondary endpoints:
Between group analyses for ethnic groups in each arm were done using two-tailed chi-
squared tests for statin pickup and t-tests for LDL.
Secondary endpoints showed some changes for statin pickup and LDL levels. For statin
pickup at 3 months, there was a significant difference between ethnic groups in the non-
PHASE arm (p = 0.03), but no significant difference between ethnic groups in PHASE (p =
0.236). At 6 month statin pickup, both non-PHASE and PHASE arms showed no
significant differences between ethnic groups (p = 0.188 and p = 0.265, respectively).
Table 3: Summary of secondary endpoints
Non-PHASE
LDL at 3 months
•Difference between ethnic groups (Asian,
AA, Hispanic, White)
No
significant
differences
LDL at 6 months
•Difference between ethnic groups (Asian,
AA, Hispanic, White)
No
significant
differences
PHASE
LDL at 3 months
•Difference between ethnic groups (Asian,
AA, Hispanic, White)
No
significant
differences
LDL at 6 months
•Hispanic vs White p = 0.005
In terms of LDL differences at 3 months and 6 months,
there were no significant interethnic differences in either
the non-PHASE or PHASE groups except in one scenario.
Statistical significance was observed when comparing
Hispanic vs White for 6 month LDL in the PHASE arm (p =
0.005).