Abstract
BackgroundIndividuals with complex dyslipidemia, or those with medication intolerance, are often difficult to manage in primary care. They require the additional attention, expertise, and adherence counseling that occurs in multidisciplinary lipid clinics (MDLCs). We conducted a program evaluation of the first year of a newly implemented MDLC utilizing the RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) framework to provide empirical data not only on program effectiveness, but also on components important to local sustainability and future generalizability.MethodsThe purpose of the MDLC is to increase the uptake of guideline-based care for lipid conditions. Established in 2019, the MDLC provides care via a centralized clinic location within the healthcare system. Primary care providers and cardiologists were invited to refer individuals with lipid conditions. Using a pre/post-study design, we evaluated the implementation outcomes from the MDLC using the RE-AIM framework.ResultsIn 2019, 420 referrals were made to the MDLC (reach). Referrals were made by 19% (148) of the 796 active cardiology and primary care providers, with an average of 35 patient referrals per month in 2019 (SD 12) (adoption). The MDLC saw 83 patients in 2019 (reach). Additionally, 50% (41/82) had at least one follow-up MDLC visit, and 12% (10/82) had two or more follow-up visits in 2019 (implementation). In patients seen by the MDLC, we found an improved diagnosis of specific lipid conditions (FH (familial hypercholesterolemia), hypertriglyceridemia, and dyslipidemia), increased prescribing of evidence-based therapies, high rates of medication prior authorization approvals, and significant reductions in lipid levels by lipid condition subgroup (effectiveness). Over time, the operations team decided to transition from in-person follow-up to telehealth appointments to increase capacity and sustain the clinic (maintenance).ConclusionsDespite limited reach and adoption of the MDLC, we found a large intervention effect that included improved diagnosis, increased prescribing of guideline-recommended treatments, and clinically significant reduction of lipid levels. Attention to factors including solutions to decrease the large burden of unseen referrals, discussion of the appropriate number and duration of visits, and sustainability of the clinic model could aid in enhancing the success of the MDLC and improving outcomes for more patients throughout the system.
Highlights
Individuals with complex dyslipidemia, or those with medication intolerance, are often difficult to manage in primary care
Attention to factors including solutions to decrease the large burden of unseen referrals, discussion of the appropriate number and duration of visits, and sustainability of the clinic model could aid in enhancing the success of the Multidisciplinary lipid clinic (MDLC) and improving outcomes for more patients throughout the system
Limited capacity and resources for MDLCs may limit their ability to meet the patient demand within a large healthcare system
Summary
Individuals with complex dyslipidemia, or those with medication intolerance, are often difficult to manage in primary care. Successful deployment of evidence-based cholesterol guidelines in these complex patients requires several clinical skills: nutrition, to improve diet and explain differences in saturated versus unsaturated fats; diagnostic expertise regarding common and rare cholesterol disorders; and pharmacology, to focus on medication titration, management, and lifelong adherence. Such MDLCs have been shown to increase the number of individuals achieving target low-density lipoprotein cholesterol (LDL-C) goals and improve lipid-lowering medication adherence, effectively lowering the CVD risk of patients seen by the MDLC [3, 7]
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