The Experts below are selected from a list of 19995 Experts worldwide ranked by ideXlab platform
Salim S Virani - One of the best experts on this subject based on the ideXlab platform.
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barriers to non hdl cholesterol Goal Attainment by providers
The American Journal of Medicine, 2011Co-Authors: Salim S Virani, Lynne Steinberg, Tyler Murray, Smita Negi, Vijay Nambi, Lechauncy D Woodard, Biykem BozkurtAbstract:Abstract Purpose Despite improvements in low-density lipoprotein cholesterol Goal Attainment, non-high-density lipoprotein cholesterol (non-HDL-C) Goal Attainment remains poor. This study assessed providers' knowledge of, attitude toward, and practice regarding non-HDL-C. Methods Based on a conceptual model, we designed a questionnaire that was administered to internal medicine, family practice, cardiology, and endocrinology providers attending continuous medical education conferences. Responses were compared with those of providers attending a clinical lipidology conference. Results The response rate was 33.3% (354/1063). Among providers attending nonlipidology conferences, only 26% knew that non-HDL-C was a secondary treatment target, 34% knew non-HDL-C treatment Goals, 56% could calculate non-HDL-C levels, and 66% knew that non-HDL-C levels could be calculated from a standard lipid panel. Compared with providers attending the lipidology conference, the other providers were less likely ( P ≤.01) to have read the Adult Treatment Panel III guidelines (46% vs 98%) or to use non-HDL-C (36% vs 91%). No differences were found between primary care and specialty providers. Lack of familiarity with Adult Treatment Panel III guidelines (34%) and of knowledge regarding non-HDL-C importance (21%) and calculation (22.7%) were the most common barriers identified. Conclusions Major gaps remain in providers' awareness regarding non-HDL-C definition, calculation, and Goals. System-level interventions are needed across specialties to address these gaps.
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institutional provider and patient correlates of low density lipoprotein and non high density lipoprotein cholesterol Goal Attainment according to the adult treatment panel iii guidelines
American Heart Journal, 2011Co-Authors: Salim S Virani, Lechauncy D Woodard, Cassie R Landrum, Kenneth Pietz, Degang Wang, Christie M Ballantyne, Laura A PetersenAbstract:Background The aim of this analysis was to identify the proportion of coronary heart disease (CHD) patients achieving guideline-recommended low-density lipoprotein cholesterol (LDL-C) and non–high-density lipoprotein cholesterol (non–HDL-C) Goals and to identify correlates of dual Goal Attainment. Methods We analyzed patient, provider, and facility characteristics for 21,801 CHD patients in one Veterans Affairs Hospitals Network. Results Low-density lipoprotein cholesterol Goal Attainment was 80%, but optional LDL-C Goal Attainment was 41%. Of patients with triglycerides ≥200 mg/dL, 51% attained both LDL-C and non–HDL-C Goals. Correlates of higher dual Goal Attainment included older age (65-74 years: odds ratio [OR] 1.47, 95% CI 1.28-1.69), diabetes (OR 1.33, 95% CI 1.16-1.53), obesity (OR 1.25, 95% CI 1.04-1.50), a higher number of primary care visits (OR 1.04, 95% CI 1.04-1.05), and mild increase in illness severity of patients in provider's panel (OR 1.20, 95% CI 1.0008-1.46), whereas African American patients were less likely to achieve dual lipid Goals (OR 0.63, 95% CI 0.48-0.82). Receipt of care from physician (vs nonphysician) or specialist (vs primary care) provider, number of patients in provider's panel, and percentage of patients in provider's panel with diagnosis of hyperlipidemia were not associated with dual Goal Attainment. Conclusions A large proportion of CHD patients attained LDL-C Goal, but optional LDL-C Goal Attainment was low. Patients with elevated triglycerides had poor Attainment of dual LDL-C and non–HDL-C Goals, suggesting a treatment gap. Factors associated with dual Goal Attainment may identify interventions needed to improve future guideline adherence.
Chernen Chiang - One of the best experts on this subject based on the ideXlab platform.
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the association between low density lipoprotein cholesterol Goal Attainment physician and patient attitudes and perceptions and healthcare policy
Journal of Atherosclerosis and Thrombosis, 2014Co-Authors: Kangling Wang, Chenghsueh Wu, Kofan Wang, Chunchin Chang, Lungching Chen, Tsemin Lu, Chernen ChiangAbstract:Aim: Withholding effective treatment is clinically prevalent. The CEntralized Pan-Asian survey on tHE Under-treatment of hypercholeSterolemia (CEPHEUS-PA) indicated suboptimal low-density lipoprotein cholesterol (LDL-C) Goal Attainment in Taiwan, which may be attributable to clinical inertia. We herein analyzed the Taiwanese cohort in the CEPHEUS-PA to identify key elements regarding clinical inertia and unsatisfactory LDL-C control. Methods: A questionnaire regarding the attitudes and perceptions for each physician and patient was included in the CEPHEUS-PA. Physicians completed the physician questionnaire before enrolling patients, who completed the patient questionnaire before the assessment. Results: The National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) guideline was used by 81.8% of physicians to establish the individual therapeutic targets; 50.2% of patients failed to take medications persistently. Regarding perceptions to hypercholesterolemia management, 75.9% of physicians were confident of having a sufficient number of patients at cholesterol targets; 80.2% and 65.9% of patients felt satisfied and motivated, respectively, but 46.0% had no strong feeling. The healthcare reimbursement policy used for treatment guidance was a significant determinant for LDL-C Goal Attainment (OR=0.32, 95% CI: 0.15-0.69, P=0.006) in addition to patient compliance. Low patient involvement indexed by having no strong feeling was associated with poor LDL-C control (OR=0.73, 95% CI: 0.56-0.95, P=0.020). Conclusions: The referenced healthcare reimbursement policy, poor patient compliance, and low patient involvement with hypercholesterolemia management were associated with failure of LDL-C control. Our findings highlight the need to overcome those barriers to improve the under-treatment of hypercholesterolemia.
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the association between low density lipoprotein cholesterol Goal Attainment physician and patient attitudes and perceptions and healthcare policy
Journal of Atherosclerosis and Thrombosis, 2014Co-Authors: Kangling Wang, Kofan Wang, Chunchin Chang, Lungching Chen, Shingjong Lin, Chernen ChiangAbstract:Aim Withholding effective treatment is clinically prevalent. The CEntralized Pan-Asian survey on tHE Under-treatment of hypercholeSterolemia (CEPHEUS-PA) indicated suboptimal low-density lipoprotein cholesterol (LDL-C) Goal Attainment in Taiwan, which may be attributable to clinical inertia. We herein analyzed the Taiwanese cohort in the CEPHEUS-PA to identify key elements regarding clinical inertia and unsatisfactory LDL-C control. Methods A questionnaire regarding the attitudes and perceptions for each physician and patient was included in the CEPHEUS-PA. Physicians completed the physician questionnaire before enrolling patients, who completed the patient questionnaire before the assessment. Results The National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) guideline was used by 81.8% of physicians to establish the individual therapeutic targets; 50.2% of patients failed to take medications persistently. Regarding perceptions to hypercholesterolemia management, 75.9% of physicians were confident of having a sufficient number of patients at cholesterol targets; 80.2% and 65.9% of patients felt satisfied and motivated, respectively, but 46.0% had no strong feeling. The healthcare reimbursement policy used for treatment guidance was a significant determinant for LDL-C Goal Attainment (OR=0.32, 95% CI: 0.15-0.69, P=0.006) in addition to patient compliance. Low patient involvement indexed by having no strong feeling was associated with poor LDL-C control (OR=0.73, 95% CI: 0.56-0.95, P=0.020). Conclusions The referenced healthcare reimbursement policy, poor patient compliance, and low patient involvement with hypercholesterolemia management were associated with failure of LDL-C control. Our findings highlight the need to overcome those barriers to improve the under-treatment of hypercholesterolemia.
Lungching Chen - One of the best experts on this subject based on the ideXlab platform.
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the association between low density lipoprotein cholesterol Goal Attainment physician and patient attitudes and perceptions and healthcare policy
Journal of Atherosclerosis and Thrombosis, 2014Co-Authors: Kangling Wang, Chenghsueh Wu, Kofan Wang, Chunchin Chang, Lungching Chen, Tsemin Lu, Chernen ChiangAbstract:Aim: Withholding effective treatment is clinically prevalent. The CEntralized Pan-Asian survey on tHE Under-treatment of hypercholeSterolemia (CEPHEUS-PA) indicated suboptimal low-density lipoprotein cholesterol (LDL-C) Goal Attainment in Taiwan, which may be attributable to clinical inertia. We herein analyzed the Taiwanese cohort in the CEPHEUS-PA to identify key elements regarding clinical inertia and unsatisfactory LDL-C control. Methods: A questionnaire regarding the attitudes and perceptions for each physician and patient was included in the CEPHEUS-PA. Physicians completed the physician questionnaire before enrolling patients, who completed the patient questionnaire before the assessment. Results: The National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) guideline was used by 81.8% of physicians to establish the individual therapeutic targets; 50.2% of patients failed to take medications persistently. Regarding perceptions to hypercholesterolemia management, 75.9% of physicians were confident of having a sufficient number of patients at cholesterol targets; 80.2% and 65.9% of patients felt satisfied and motivated, respectively, but 46.0% had no strong feeling. The healthcare reimbursement policy used for treatment guidance was a significant determinant for LDL-C Goal Attainment (OR=0.32, 95% CI: 0.15-0.69, P=0.006) in addition to patient compliance. Low patient involvement indexed by having no strong feeling was associated with poor LDL-C control (OR=0.73, 95% CI: 0.56-0.95, P=0.020). Conclusions: The referenced healthcare reimbursement policy, poor patient compliance, and low patient involvement with hypercholesterolemia management were associated with failure of LDL-C control. Our findings highlight the need to overcome those barriers to improve the under-treatment of hypercholesterolemia.
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the association between low density lipoprotein cholesterol Goal Attainment physician and patient attitudes and perceptions and healthcare policy
Journal of Atherosclerosis and Thrombosis, 2014Co-Authors: Kangling Wang, Kofan Wang, Chunchin Chang, Lungching Chen, Shingjong Lin, Chernen ChiangAbstract:Aim Withholding effective treatment is clinically prevalent. The CEntralized Pan-Asian survey on tHE Under-treatment of hypercholeSterolemia (CEPHEUS-PA) indicated suboptimal low-density lipoprotein cholesterol (LDL-C) Goal Attainment in Taiwan, which may be attributable to clinical inertia. We herein analyzed the Taiwanese cohort in the CEPHEUS-PA to identify key elements regarding clinical inertia and unsatisfactory LDL-C control. Methods A questionnaire regarding the attitudes and perceptions for each physician and patient was included in the CEPHEUS-PA. Physicians completed the physician questionnaire before enrolling patients, who completed the patient questionnaire before the assessment. Results The National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) guideline was used by 81.8% of physicians to establish the individual therapeutic targets; 50.2% of patients failed to take medications persistently. Regarding perceptions to hypercholesterolemia management, 75.9% of physicians were confident of having a sufficient number of patients at cholesterol targets; 80.2% and 65.9% of patients felt satisfied and motivated, respectively, but 46.0% had no strong feeling. The healthcare reimbursement policy used for treatment guidance was a significant determinant for LDL-C Goal Attainment (OR=0.32, 95% CI: 0.15-0.69, P=0.006) in addition to patient compliance. Low patient involvement indexed by having no strong feeling was associated with poor LDL-C control (OR=0.73, 95% CI: 0.56-0.95, P=0.020). Conclusions The referenced healthcare reimbursement policy, poor patient compliance, and low patient involvement with hypercholesterolemia management were associated with failure of LDL-C control. Our findings highlight the need to overcome those barriers to improve the under-treatment of hypercholesterolemia.
Jo Anne M Foody - One of the best experts on this subject based on the ideXlab platform.
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use of health information technology hit to improve statin adherence and low density lipoprotein cholesterol Goal Attainment in high risk patients proceedings from a workshop
Journal of Clinical Lipidology, 2013Co-Authors: Jerome D Cohen, Jo Anne M Foody, Karen E Aspry, Alan S Brown, Roy Furman, Terry A Jacobson, Dean G Karalis, Penny M Krisetherton, Ralph Laforge, Michael F OtooleAbstract:Abstract The workshop discussions focused on how low-density lipoprotein cholesterol (LDL-C) Goal Attainment can be enhanced with the use of health information technology (HIT) in different clinical settings. A gap is acknowledged in LDL-C Goal Attainment, but because of the passage of the American Recovery & Reinvestment Act and the Health Information Technology for Economic and Clinical Health Acts there is now reason for optimism that this gap can be narrowed. For HIT to be effectively used to achieve treatment Goals, it must be implemented in a setting in which the health care team is fully committed to achieving these Goals. Implementation of HIT alone has not resulted in reducing the gap. It is critical to build an effective management strategy into the HIT platform without increasing the overall work/time burden on staff. By enhancing communication between the health care team and the patient, more timely adjustments to treatment plans can be made with greater opportunity for LDL-C Goal Attainment and improved efficiency in the long run. Patients would be encouraged to take a more active role. Support tools are available. The National Lipid Association has developed a toolkit designed to improve patient compliance and could be modified for use in an HIT system. The importance of a collaborative approach between nongovernmental organizations such as the National Lipid Association, National Quality Forum, HIT partners, and other members of the health care industry offers the best opportunity for long-term success and the real possibility that such efforts could be applied to other chronic conditions, for example, diabetes and hypertension.
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switching from high efficacy lipid lowering therapies to simvastatin and low density lipoprotein cholesterol Goal Attainment in coronary heart disease coronary heart disease equivalent patients
Journal of Clinical Lipidology, 2010Co-Authors: Kaan Tunceli, Shiva Sajjan, Dena R Ramey, David Neff, Andrew M Tershakovec, Joanne E Tomassini, Jo Anne M FoodyAbstract:Background The availability of generic simvastatin in 2006 has prompted substantial changes in formulary recommendations for lipid-management agents. Objective To assess the impact of switches from high-efficacy lipid-lowering therapy to simvastatin on low-density lipoprotein cholesterol (LDL-C) and Goal Attainment in coronary heart disease (CHD) or CHD risk-equivalent patients in a managed care setting. Methods In this retrospective observational study, we estimated the least squares mean difference in the percent change from baseline LDL-C and the odds ratios for LDL-C Goal Attainment rates ( Results We identified 18,061 patients who, between September 1, 2004 and October 31, 2008, were either switched from or remained on their initial high-efficacy LDL-C lowering therapy: ezetimibe/simvastatin fixed-dose combination (E/S), rosuvastatin, or atorvastatin. The difference in percent change in LDL-C levels from baseline were 25.2 (95% confidence interval 21.2−29.2), 13.0 (6.0−20.0), and 3.1 (0.3−5.9) greater in switchers to simvastatin in the E/S, rosuvastatin, and atorvastatin comparisons, respectively, after adjusting for age, sex, and starting dose of the initial therapy. For switchers, the percent of patients at LDL-C Conclusions Among CHD/CHD risk-equivalent patients, switching to simvastatin was associated with increases in LDL-C levels and lower LDL-C Goal Attainment rates. The public health impact of this phenomenon on population risk and CHD events remains to be determined.
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a comparison of non hdl and ldl cholesterol Goal Attainment in a large multinational patient population the lipid treatment assessment project 2
Atherosclerosis, 2009Co-Authors: Raul D Santos, David D Waters, Lisa Tarasenko, Michael Messig, Wouter J Jukema, Cheng Wen Chiang, Jean Ferrieres, Jo Anne M FoodyAbstract:Abstract Objective This study evaluated the success in attaining non-HDL-cholesterol (non-HDL-C) Goals in the multinational L-TAP 2 study. Methods 9955 patients ≥20 years of age with dyslipidemia on stable lipid-lowering therapy were enrolled from nine countries. Results Success rates for non-HDL-C Goals were 86% in low, 70% in moderate, and 52% in high-risk patients (63% overall). In patients with triglycerides of >200 mg/dL success rates for non-HDL-C Goals were 35% vs. 69% in those with ≤200 mg/dL ( p Conclusions Non-HDL-C Goal Attainment lagged behind LDL-C Goal Attainment; this gap was greatest in higher-risk patients.
Kangling Wang - One of the best experts on this subject based on the ideXlab platform.
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the association between low density lipoprotein cholesterol Goal Attainment physician and patient attitudes and perceptions and healthcare policy
Journal of Atherosclerosis and Thrombosis, 2014Co-Authors: Kangling Wang, Chenghsueh Wu, Kofan Wang, Chunchin Chang, Lungching Chen, Tsemin Lu, Chernen ChiangAbstract:Aim: Withholding effective treatment is clinically prevalent. The CEntralized Pan-Asian survey on tHE Under-treatment of hypercholeSterolemia (CEPHEUS-PA) indicated suboptimal low-density lipoprotein cholesterol (LDL-C) Goal Attainment in Taiwan, which may be attributable to clinical inertia. We herein analyzed the Taiwanese cohort in the CEPHEUS-PA to identify key elements regarding clinical inertia and unsatisfactory LDL-C control. Methods: A questionnaire regarding the attitudes and perceptions for each physician and patient was included in the CEPHEUS-PA. Physicians completed the physician questionnaire before enrolling patients, who completed the patient questionnaire before the assessment. Results: The National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) guideline was used by 81.8% of physicians to establish the individual therapeutic targets; 50.2% of patients failed to take medications persistently. Regarding perceptions to hypercholesterolemia management, 75.9% of physicians were confident of having a sufficient number of patients at cholesterol targets; 80.2% and 65.9% of patients felt satisfied and motivated, respectively, but 46.0% had no strong feeling. The healthcare reimbursement policy used for treatment guidance was a significant determinant for LDL-C Goal Attainment (OR=0.32, 95% CI: 0.15-0.69, P=0.006) in addition to patient compliance. Low patient involvement indexed by having no strong feeling was associated with poor LDL-C control (OR=0.73, 95% CI: 0.56-0.95, P=0.020). Conclusions: The referenced healthcare reimbursement policy, poor patient compliance, and low patient involvement with hypercholesterolemia management were associated with failure of LDL-C control. Our findings highlight the need to overcome those barriers to improve the under-treatment of hypercholesterolemia.
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the association between low density lipoprotein cholesterol Goal Attainment physician and patient attitudes and perceptions and healthcare policy
Journal of Atherosclerosis and Thrombosis, 2014Co-Authors: Kangling Wang, Kofan Wang, Chunchin Chang, Lungching Chen, Shingjong Lin, Chernen ChiangAbstract:Aim Withholding effective treatment is clinically prevalent. The CEntralized Pan-Asian survey on tHE Under-treatment of hypercholeSterolemia (CEPHEUS-PA) indicated suboptimal low-density lipoprotein cholesterol (LDL-C) Goal Attainment in Taiwan, which may be attributable to clinical inertia. We herein analyzed the Taiwanese cohort in the CEPHEUS-PA to identify key elements regarding clinical inertia and unsatisfactory LDL-C control. Methods A questionnaire regarding the attitudes and perceptions for each physician and patient was included in the CEPHEUS-PA. Physicians completed the physician questionnaire before enrolling patients, who completed the patient questionnaire before the assessment. Results The National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) guideline was used by 81.8% of physicians to establish the individual therapeutic targets; 50.2% of patients failed to take medications persistently. Regarding perceptions to hypercholesterolemia management, 75.9% of physicians were confident of having a sufficient number of patients at cholesterol targets; 80.2% and 65.9% of patients felt satisfied and motivated, respectively, but 46.0% had no strong feeling. The healthcare reimbursement policy used for treatment guidance was a significant determinant for LDL-C Goal Attainment (OR=0.32, 95% CI: 0.15-0.69, P=0.006) in addition to patient compliance. Low patient involvement indexed by having no strong feeling was associated with poor LDL-C control (OR=0.73, 95% CI: 0.56-0.95, P=0.020). Conclusions The referenced healthcare reimbursement policy, poor patient compliance, and low patient involvement with hypercholesterolemia management were associated with failure of LDL-C control. Our findings highlight the need to overcome those barriers to improve the under-treatment of hypercholesterolemia.