Abstract 269: Variation in Cholesterol Documentation and Control in Different Clinics Run by the Same Provider

Abstract

Background: Cholesterol level availability during a patient’s clinic visit can enhance decision-making with regards to lipid assessment and therapy, and help achieve therapeutic targets. Methods: Clinic encounters from a 2 clinics run by the same cardiologist; a University-based clinic and a Veterans Administration (VA) clinic were compared for availability of lipid profiles and level of lipid control in patients with documented coronary disease. Results: There were 93 out of 300 patient encounters (31%) with documented coronary disease in the University-based clinic and 77 out of 134 patient encounters (57%) in the VA-based clinic. University patients with CAD had 61% (57/93) lipid documentation during their encounters, while VA patients had 99% (76/77) documentation. The average total cholesterol and LDL for University patients was 179 +/- 42 mg/dL and 111 +/- 35 mg/dL respectively, compared with 154 +/- 38 mg/dL and 93+/- 35 mg/dL for the VA patients respectively (P < 0.01 for each category). Only 39% (22/57) of the University-based patients achieved < 100 mg/dL, compared with 66% (51/77) of VA patients. Blood pressures, which were consistently documented every clinic visit in both clinics, averaged 128/76 mmHg in the University clinic compared with 131/75 mmHg in the VA clinic, with no statistically significant differences. Conclusion: Overall, better control of cholesterol levels is seen in the VA-based clinic compare with the University-based clinic. This may partially be explained by the result availability through a unified computer system, allowing more prompt decision-making with regards to medication changes and intensified dietary counseling during the clinic encounter. This is may not be available in other settings where laboratory tests are performed by a different provider utilizing a different reporting system which may not be readily shared or available to the treating cardiologist. Other factors could include variable compliance with laboratory appointments and access to medications.