Laboratory Test Requests Research Articles

Sevenfold rise in likelihood of pertussis test requests in a stable set of Australian general practice encounters, 2000–2011

To better understand the role that diagnostic test-ordering behaviour of general practitioners has on current pertussis epidemiology in Australia. Analysis of Australian general practice encounter data (from the Bettering the Evaluation and Care of Health [BEACH] program) on 13 "pertussis-related problem" (PRP) codes that were most likely to result in a pertussis laboratory test request and Australian pertussis notifications data (from the National Notifiable Diseases Surveillance System [NNDSS]) for the period April 2000 to March 2011. The change in the proportion of PRP general practice encounters with a pertussis test request between 2000 and 2011, and the change in national pertussis notifications over the same period. The proportion of PRP encounters resulting in a pertussis test request increased from 0.25% between April 2000 and March 2004 to 1.71% between April 2010 and March 2011 (odds ratio, 7.0; 95% CI, 5.5-8.8). The BEACH data on pertussis testing and NNDSS data on pertussis notifications were highly correlated (r = 0.99), and the notification data mirrored the likelihood of a pertussis test request in general practice. The proportion of NNDSS pertussis notifications with a polymerase chain reaction (PCR)-confirmed diagnosis increased from 16.3% between April 2000 and March 2004 to 65.3% between April 2010 and March 2011. An increase in pertussis testing following recognition of early epidemic cases may have led to identification of previously undetected infections, resulting in a further increase in notified disease and awareness among GPs. The changing likelihood of being tested may also be due to expanding availability and use of PCR testing in Australia.

Appropriateness of the request for laboratory tests in the diagnosis of systemic autoimmune diseases

Autoimmune diseases are caused by an immune response against some autoantigens. This response, characterized by the presence of autoantibodies, causes an inflammatory disease, which can cause a damage of specific organ (organ-specific autoimmune diseases) or systemic (systemic autoimmune diseases). The presence of these autoantibodies in the serum can therefore be a useful parameter for the diagnosis and/or monitoring of autoimmune diseases In this paper we describe a flow chart about laboratory tests in the diagnosis of systemic autoimmune diseases so as to maintain appropriateness of the request and contain costs.

Exploratory analysis of methods for automated classification of laboratory test orders into syndromic groups in veterinary medicine.

BackgroundRecent focus on earlier detection of pathogen introduction in human and animal populations has led to the development of surveillance systems based on automated monitoring of health data. Real- or near real-time monitoring of pre-diagnostic data requires automated classification of records into syndromes–syndromic surveillance–using algorithms that incorporate medical knowledge in a reliable and efficient way, while remaining comprehensible to end users.MethodsThis paper describes the application of two of machine learning (Naïve Bayes and Decision Trees) and rule-based methods to extract syndromic information from laboratory test requests submitted to a veterinary diagnostic laboratory.ResultsHigh performance (F1-macro = 0.9995) was achieved through the use of a rule-based syndrome classifier, based on rule induction followed by manual modification during the construction phase, which also resulted in clear interpretability of the resulting classification process. An unmodified rule induction algorithm achieved an F1-micro score of 0.979 though this fell to 0.677 when performance for individual classes was averaged in an unweighted manner (F1-macro), due to the fact that the algorithm failed to learn 3 of the 16 classes from the training set. Decision Trees showed equal interpretability to the rule-based approaches, but achieved an F1-micro score of 0.923 (falling to 0.311 when classes are given equal weight). A Naïve Bayes classifier learned all classes and achieved high performance (F1-micro = 0.994 and F1-macro = .955), however the classification process is not transparent to the domain experts.ConclusionThe use of a manually customised rule set allowed for the development of a system for classification of laboratory tests into syndromic groups with very high performance, and high interpretability by the domain experts. Further research is required to develop internal validation rules in order to establish automated methods to update model rules without user input.

Improving laboratory test requests can reduce costs in ICUs

Improving laboratory test requests can reduce costs in ICUs

Prenatal care: a look at the quality

This study aimed to assess the quality of prenatal care according to the criteria established in the Prenatal and Birth Humanization Program. Cross-sectional, descriptive and exploratory study carried out with 75 pregnant women registered in Basic Health Units of a municipality in the metropolitan region of Fortaleza, Ceará, Brazil. Data were collected between March and May, 2011, through interviews during prenatal nursing consultations. One highlighted major obstacles to a good quality prenatal care: deficits in the request of second routine laboratory tests in prenatal care, significant number of pregnant women who were not tested for fetal presentation and a small number of pregnant women who did not have the updated vaccine schedule. However investment is necessary to encourage and qualify professionals to perform their practices with a better performance. These practices can be developed through educational and health actions in order to improve the quality of prenatal care.

When Thyroidologists Agree to Disagree: Comments on the 2012 Endocrine Society Pregnancy and Thyroid Disease Clinical Practice Guideline

When Thyroidologists Agree to Disagree: Comments on the 2012 Endocrine Society Pregnancy and Thyroid Disease Clinical Practice Guideline

Using pathology-specific laboratory profiles in Clinical Pathology to reduce inappropriate test requesting: two completed audit cycles

BackgroundSystematic reviews have shown that, although well prepared, the Consensus Guidelines have failed to change clinical practice. In the healthcare district of Castelnovo né Monti (Reggio Emilia, Italy), it became necessary for the GPs and Clinical Pathologists to work together to jointly define laboratory profiles.MethodsObservational study with two cycles of retrospective audit on test request forms, in a primary care setting. Objectives of the study were to develop pathology-specific laboratory profiles and to increase the number of provisional diagnoses on laboratory test request forms. A Multiprofessional Multidisciplinary Inter-hospital Work Team developed pathology-specific laboratory profiles for more effective test requesting. After 8 training sessions that used a combined strategy with multifaceted interventions, the 23 General Practitioners (GPs) in the trial district (Castelnovo nè Monti) tested the profiles; the 21 GPs in the Puianello district were the control group; all GPs in both districts participated in the trial. All laboratory tests for both healthcare districts are performed at the Laboratory located in the trial district. A baseline and a 1-year audit were performed in both districts on the GPs’ request forms.ResultsSeven pathology-specific laboratory profiles for outpatients were developed. In the year after the first audit cycle: 1) the number of tests requested in the trial district was distinctly lower than that in the previous year, with a decrease of about 5% (p < 0.001); 2) the provisional diagnosis on the request forms was 52.8% in the trial district and 42% in the control district (P < 0.001); 3) the decrease of the number of tests on each request form was much more marked in the trial district (8.73 vs. 10.77; p < 0.001).ConclusionsThe first audit cycle showed a significant decrease in the number of tests ordered only in the trial district. The combined strategy used in this study improved the prescriptive compliance of most of the GPs involved. The presence of the clinical pathologist is seen as an added value.

Use of high fidelity human patient simulation (HPS) in second year medical pharmacology instruction

This study examined the use of HPS (Laerdal SimMan 3G) in a pharmacology general principles course and its impact on student learning, critical thinking and problem‐solving. Eight simulation cases were developed: six involving the autonomic nervous system and two with pain management. Students were assigned to one of 36 teams consisting of 5–6 members. Each team encountered only one case scenario. Teams were required to take a patient history, perform a physical exam, request laboratory tests, make a diagnosis, administer appropriate pharmacotherapy and monitor treatment outcome. Two different scenarios were performed concurrently and the two teams were then combined for a student led debriefing session that was faculty facilitated. Student survey comments were extremely positive. Results from 195 students included HPS complemented the course objectives (5.0 out of 5.0), promoted higher level, critical thinking (4.9/5.0), was a more effective learning experience than lectures alone (4.9/5.0) and improved student ability to function as a health professional team (4.7/5.0). We conclude that HPS provides an effective learning experience that encourages active learning and problem‐solving skills as a member of a health professional team.

Economic Analysis of Requests for Laboratory Tests in Primary Health Care Centers

Introduction:Operation of the Primary health care center and Medical-biochemical laboratories depends on the number of performed laboratory tests. The number of unnecessary tests significantly affect the operation of health institutions.Material and methods:We analyzed the 1000 requests for laboratory tests at the Primary Health Care Centre in Gracanica from primary care units. Based on the requests for laboratory diagnostics advisable diagnoses from primary health care unit in the Primary Health Care Center (PHC) we made an economic analysis of the total required laboratory tests in the requests for laboratory diagnosis. Incorporating the economic analysis of laboratory tests in requests for laboratory diagnosis by doctors in primary health care (PHC) and the economic analysis of laboratory tests by the disease in primary health care.Results:The economic value of 5333 laboratory tests was 84 312 points (1 point is 0.80 KM). Of the total value of the index score requirements of GPs are 44, 1%, the requirement of family doctors account for 40% and requirements of other specialists make up 15, 9%.. Discussion: In the requests of the PHC units for laboratory tests are required all levels of services: urine, CBC, SE, glucose, bilirubine, ALT, AST, AF, CK, cholesterol, HDL chol., triglicerdes, creatinine, urea, uric acid, CRP, fibrinogen, calcium and phosphorus. The following requests are the most common laboratory tests: urine, CBC, blood glucose, cholesterol, triglycerides, aminotransferases, creatinine, urea. The doctors in family practice most often requested: blood glucose, urine, CBC, SE, TGL. , Chol., ALT, AST, creatinine and urea. General practitioners were demanding more cholesterol and triglycerides, and family medicine doctors were demanding less cholesterol and triglycerides and more often CRP, fibrinogen, ALT, AST, what from the level of economic cost analysis rises the issue whether this was justified?

Effects of sample transportation on commonly requested laboratory tests

Little evidence is available in literature on the effects of sample transportation. The aim of the present study was to evaluate the effects of an integrated system for sample transportation on the quality of six laboratory parameters considered representative of the quality of all tests requested and performed. The values of alanine aminotransferase (ALT), calcium (Ca), potassium (K), activated prothrombin time (APTT), prostate specific antigen (PSA), and hemoglobin (Hb) obtained in samples collected in peripheral centers in 2007 were compared with those obtained in 2011, following the introduction of the integrated transportation system entailing a tertiary and a secondary container, a data-logger for registering time and temperature, a mission starter and a system manager. In 2007, for ALT, APTT and K, there were significant variations between findings for samples transported from long-term and those from short-term peripheral centers; following the introduction of the transportation system, no such variations were found. Improvement in the quality of sample transportation has been achieved, particularly for three of the six parameters evaluated, following the introduction of the integrated system described in the present study.

Identification of Sex-Determining Region Y (SRY) in Maternal Plasma after Paternal Lymphocyte Immunization: Is it Possible?

Women treated with allogeneic immunization using paternal lymphocytes often request laboratory molecular tests using cell-free fetal DNA in maternal plasma. There is concern whether the treatment can interfere with its results. This study evaluated the applicability of fetal sex determination using fragments of sex-determining region Y (SRY) in the plasma of women submitted to paternal lymphocyte immunization. Non-pregnant women blood samples were collected at two different moments: prior to paternal lymphocyte immunization and after three doses of the immunotherapy, in a prospective study. For women who became pregnant, another sample was collect during the first trimester. Amplification of the fragment of the Y chromosome (SRY) was performed using real-time PCR. The SRY gene was not identified in any of the plasma samples of the 50 non-pregnant women submitted to paternal lymphocyte immunization at either of the two moments evaluated. For the 26 pregnant women, the results of the identification of sex -determining in maternal plasma were completely in agreement with the infant sex. Paternal lymphocyte immunization does not affect the results of SRY fragment investigation in the plasma of women submitted to paternal lymphocyte immunization therapy.

High frequency of inadequate test requests for antiphospholipid antibodies in daily clinical practice

We have empirically noted that many physicians routinely request anti-phospholipid antibodies (aPL) without a correct clinical indication. The aim of this study was to evaluate retrospectively whether aPL testing at our Thrombosis Centre was justified. Medical records from 520 subjects for aPL screening tests for various clinical conditions were reviewed. The aPL screening tests were: lupus anticoagulant (LA), anti-cardiolipin antibodies (aCL) and anti-β(2) glycoptotein I (aβ(2) GPI). Requests for aPL screening were divided into justified, potentially justified or not adequately justified. aPL testing requests were considered justified in 358 (69%) patients, potentially justified in 66 (12.6%) and not adequately justified in 96 (18.4%). LA was positive in 65 (18%) of justified requests and in only one (1%) of the 96 potentially justified requests. None of the 66 not adequately justified for aPL testing was positive for LA. aβ(2) GPI was positive in 63 (17.6%) of the 358 justified, in four (6%) of the 66 potentially justified and in five (5.2%) of the 96 not adequately justified requests; aCL IgG were positive in 59 (16.4%) of the 358 justified and in five (7.5%) and six (6.2%) of the potentially justified and not adequately justified requests, respectively. The presence of the triple aPL positivity was found exclusively in the justified requests. This study suggests that requests for aPL tests should be addressed more adequately. This work could be an example of how to focus attention on requests for laboratory tests especially on the basis of valid clinical criteria before the analyte is measured.

Metabolic testing in children with cerebral palsy: less doing and more thinking?

Paediatric medicine has made considerable progress over the last decades in identifying the metabolic background of rare diseases in children. It is always impressive and very satisfying when an unsolved clinical problem is finally understood and – in the best case – leads to improved treatment and prevention. As a result of this success, an increasing number of laboratory tests for the diagnosis of various metabolic diseases have become available, allowing extension of metabolic work-ups albeit with increasing cost implications. Considering that hundreds of metabolic diseases have been described, it is obvious that no single specialist can oversee these conditions clinically nor dares to exclude their possible presence in a patient without further laboratory tests. Needless to say that the doctor’s request for resource-intense laboratory tests become a routine in all cases where clinical diagnosis remains uncertain and that a less experienced doctor tends to resort to metabolic testing more often than a more experienced colleague. The reason, namely to reduce any risk of overlooking a rare condition that the less experienced might be faced with for the first time, is fully understandable. It is not surprising then, that a child with cerebral palsy (CP) too will be tested for inherited metabolic disorders if no other aetiology is emerging, e.g. if imaging results are negative. The study presented by Leonard et al. from the Royal Children’s Hospital in Melbourne has answered the question of whether children with CP and normal imaging should undergo testing for inherited metabolic disorders.1 The answer is ‘no’: in a population-based group of 730 children with CP, 515 of these had available imaging, 54 were confirmed as normal and comprehensive metabolic testing failed to further clarify the aetiology in any of them. However, we should not throw out the baby with the bathwater: the clue to metabolic diseases is the history with positive signs including a typical (time) course, such as (1) chronic progression, (2) loss of acquired skills, and/or (3) association with organ failures other than the central nervous system. Importantly, as long as CP remains an umbrella term careful consideration of whether or not a metabolic disorder may be involved will help to focus the available resources on the very few who would likely benefit from a closer look at possible metabolic defects.

Role of Laboratory Diagnostic Medical Biochemistry Services - Analysis of Requirements for the Laboratory Test in the Laboratory of primary Health Care Center

Laboratory diagnosis of medical biochemistry activity plays a significant role in the Primary Health Care Center (PHCC), dominated by Family medicine and diagnostic services. Medical biochemical diagnosis has a visible place at all levels of health care, which shows the number of requests for laboratory diagnosis, number and type of required laboratory tests. The study included 1000 requests for laboratory tests at the PHCC in Gracanica in primary health care units. We made an analysis of the most common laboratory tests in the requests by doctors from primary health care based on requests for laboratory diagnosis. The requests of primary health care units in PHCC laboratory tests are required at all levels of service: urine, WBC, SE, glucose, total bilirubin, ALT, AST, AF, CK, cholesterol, HDL cholesterol, triglycerides, creatinine, urea, uric acid, CRP, fibrinogen, calcium and phosphorus. The following requirements are the most common laboratory tests with 94% representation: urine, WBC, glucose, cholesterol, triglycerides, aminotransferases, creatinine, and urea. In 1000 requires was required total of 5333 laboratory tests. Test requirements of a general practice make 44, 1%; FM doctors account for 40% and the requirements of other specialists (pediatricians, gynecologists and specialists of occupational medicine) are 15, 3%. The doctors in family practice most often required: glucose, urine, WBC, SE, TGL., Chol., ALT, AST, creatinine and urea. General practitioners are demanding more cholesterol and triglycerides, a family medicine doctors are demanding lower cholesterol and triglycerides and higher CRP, fibrinogen, total bilirubin, ALT, AST, and other specialists the most demanded urine and WBC. Laboratory diagnosis is a common diagnosis, which shows the representation of required number and type of laboratory tests. In requirements of PHC units in PHCC laboratory tests are required at all levels of service: urine, WBC, SE, glucose, bilirubin, ALT, AST, AF, CK, cholesterol, HDLchol., triglycerides, creatinine, urea, uric acid, CRP, fibrinogen, calcium and phosphorus. The following requirements are the most common laboratory tests at the primary level: urine, WBC, glucose, cholesterol, urea, and found the secondary level of triglycerides, index levels and did not clear the number of searches required by the standards and norms of PHC.

Economic Analysis of Requests for Laboratory Tests in Primary Health Care Centers

Economic Analysis of Requests for Laboratory Tests in Primary Health Care Centers

Guidelines for the order process of medical laboratory tests

This document presents the requirements enumerated in the ISO 15189 standard to make reliable the formulation of a medical laboratory test order. The contents and the filling conditions of the request laboratory tests form are described, to clarify the interest of the information required. The purpose is to help to construct a specific formulation allowing the adequate realization of the laboratory tests but also to collect the needed clinical information essential to allow a relevant interpretation of the results with a goal of improvement of patient care. We present also the main forms required for special laboratory tests, particularly concerning the human genome. Finally, the criteria to be reviewed at the entry of the laboratory (contract review) during the request acceptation before its registration are enumerated.

National Survey on Abdominal Trauma Practices of Pediatric Surgeons

Pediatric blunt abdominal trauma is a frequent reason for hospital admission, but there are no established guidelines to assess these patients. Our study aims to evaluate the diagnostic process used by pediatric surgeons in Switzerland to evaluate abdominal trauma. A scenario-based survey was carried out among Swiss pediatric surgeons. Respondents were asked to report on their management of children with blunt abdominal trauma. The response rate was 46% (26 of 54). The clinical signs considered the most important were abdominal examination and palpation (100%), auscultation (81%), external genital exam (77%) and Glasgow Coma Scale (77%). The most frequent laboratory exams requested were urine analysis (100%), complete blood count (96%), liver function tests (85%) and coagulation tests (77%). 42% of the physicians asked for an abdominal ultrasound for every patient with blunt abdominal trauma. 58% reported that some patients do not need a CT scan despite anomalies in the initial workup. There were significant variations in the clinical assessment of patients with minor blunt abdominal trauma. Abnormal ultrasounds, but not abnormal liver functions tests, prompted clinicians to obtain CT scans. When evaluating the probability of organ injury after a full workup, clinicians relied on the results of the ultrasound but not on liver function tests. A normal CT scan did not appear to reassure physicians if the patient still presented with mild abdominal pain. There is a wide variation in the clinical assessment, request for laboratory tests and use of radiological exams among Swiss pediatric surgeons. Further studies are required on the evaluation of abdominal organ injuries in children.

Physician-pharmacist collaborative care in dyslipidemia management: The perception of clinicians and patients

Background Collaborative practices allow physicians and pharmacists to comanage pharmacotherapy to maximize the benefits of medication regimens. The Trial to Evaluate an Ambulatory primary care Management program for patients with dyslipidemia (TEAM) study compared the efficacy of a physician-pharmacist collaborative primary care (PPCC) intervention, where pharmacists requested laboratory tests and adjusted medication dosage, to the usual care (UC) for patients under treatment with lipid-lowering medication. Objective In a qualitative study nested within the TEAM study, the perceptions of physicians, pharmacists, and patients regarding the PPCC model, interprofessional collaboration, and the clinicians' willingness to implement the model in their practice were explored. Methods In the area of Montreal (Quebec, Canada), TEAM study participants assigned to the PPCC group were invited to participate. Individual semistructured interviews with physicians (n = 7) and 2 six-member focus groups with pharmacists (n = 12) and patients (n = 12) were analyzed using a phenomenological approach. Results The vast majority of participants reported PPCC was more structured and systematic than the UC they had received previously, wherein physicians prescribe and adjust pharmacotherapy and pharmacists provide the counseling and dispense medications. Many patients felt they received better follow-up and reported being reassured and well informed, making them more inclined to care for themselves better. These feelings were attributed largely to the pharmacists' accessibility and ability to communicate with them easily. Given the physician shortage, physicians perceived interprofessional collaboration as almost inevitable. They considered PPCC to be safe and effective. However, obstacles were also identified. Physicians were concerned that it might alter their special relationship with patients and threaten their overall medical follow-up. Pharmacists felt enthusiastic about their new role, but found PPCC time consuming and thought it might not be applicable to all the patients. Conclusions PPCC model was highly appreciated by patients, and clinicians saw it as beneficial to patients. However, several obstacles still have to be overcome before the model can be implemented in the current health care context.

Anatomical pathology errors and the classic laboratory test cycle at Muhimbili National Hospital, Dar es Salaam, Tanzania

Backbround: Due to its complex nature, anatomical pathology practice is inherently error prone. Currently, there is a tendency towards an increase in errors in pathology which stems out from medical practices of other medical disciplines at Muhimbili National Hospital and thus there is a need to have error reduction strategies combined with an attempt to apply these strategies. Objective: To determine errors in anatomic pathology in relation to the classic laboratory test cycle and discuss factors contributing to these errors. Study design: The study was a descriptive cross-sectional one in which the information analyzed was obtained from pre-analytic,analytic and pot-analytic phases of the anatomical pathology laboratory test cycle. Study setting: Muhimbili National Hospital in Dar es Salaam, Tanzania. Methodology: During the pre-analytic phase of the laboratory test cycle, request forms and specimen containers containing information of patients for histological analysis of the biopsy specimens were analyzed for important parameters which had a bearing in the diagnosis. Also parameters in the analytic phase of the laboratory test cycle were analyzed for errors. The parameters analyzed here were mainly those which occurred during the histologic specimen processing, in the taking-in room, at the microscope and by clerical personnel in the laboratory. Errors which were analyzed in postanalytic phase of testing related mainly to those which resulted from delivery of the reports or information to the clinician, untimely delivery of the reports and failure of the caregiver to see the reports at all. Results: In the pre-analytic phase of laboratory testing, errors were derived and analyzed from request forms for investigation fromclinicians and from information on the containers containing biopsy specimens. Out of 13 variables analyzed from the request forms, 11(84.6 %) had errors which differed in magnitude. The highest errorswere those which arose from misleading clinical information (90%),and missing of relevant clinical information of patients (90%). However, 8 variables were also analyzed from containers and the errors which ranked highest included mislabeling on the container (85%) followed by illegibly labeling of the container (75%) and others. On the part of the analytic phase of laboratory test cycle, there were 11 variables analyzed for analytic errors and 9 (81.8 %) variables had errors, among them typographic errors had the highest frequency (45%) followed by block mislabeling (35%). In the post-analytic phase of laboratory testing, there were 3 variableswhich were analyzed for errors. The variables analyzed and the errors which were found included; delivery of the report or information to wrong clinician (10%), untimely delivery of report to the clinician (35%) and failure of the caregiver to see the report at all was (15%). Conclusion and recommendations: The numerous errors amounted in the pre-analytic, analytic and post-analytic phases of laboratory test cycles in Anatomical pathology reinforces the need for effective quality control and quality assurance at all steps in laboratory test cycle. This will be possible only and only if factors that contribute to errors be reduced to an absolute minimum through error reduction strategies combined with an attempt to apply these strategies. Additionally, incremental adoption of information technology and automation along with improved training in patient safety and quality management can help reduce errors.Key words: Anatomical pathology, Pre-analytic, Analytic, Post-analytic, Errors, Laboratory test cycle

A cluster randomized controlled Trial to Evaluate an Ambulatory primary care Management program for patients with dyslipidemia: the TEAM study

Few studies have reported the efficacy of collaborative care involving family physicians and community pharmacists for patients with dyslipidemia. We randomly assigned clusters consisting of at least two physicians and at least four pharmacists to provide collaborative care or usual care. Under the collaborative care model, pharmacists counselled patients about their medications, requested laboratory tests, monitored the effectiveness and safety of medications and patients' adherence to therapy, and adjusted medication dosages. After 12 months of follow-up, we assessed changes in low-density lipoprotein (LDL) cholesterol (the primary outcome), the proportion of patients reaching their target lipid levels and changes in other risk factors. Fifteen clusters representing a total of 77 physicians and 108 pharmacists were initially recruited, and a total of 51 physicians and 49 pharmacists were included in the final analyses. The collaborative care teams followed a total of 108 patients, and the usual care teams followed a total of 117 patients. At baseline, mean LDL cholesterol level was higher in the collaborative care group (3.5 v. 3.2 mmol/L, p = 0.05). During the study, patients in the collaborative care group were less likely to receive high-potency statins (11% v. 40%), had more visits with health care professionals and more laboratory tests, were more likely to have their lipid-lowering treatment changed and were more likely to report lifestyle changes. At 12 months, the crude incremental mean reduction in LDL cholesterol in the collaborative care group was -0.2 mmol/L (95% confidence interval [CI] -0.3 to -0.1), and the adjusted reduction was -0.05 (95% CI -0.3 to 0.2). The crude relative risk of achieving lipid targets for patients in the collaborative care group was 1.10 (95% CI 0.95 to 1.26), and the adjusted relative risk was 1.16 (95% CI 1.01 to 1.34). Collaborative care involving physicians and pharmacists had no significant clinical impact on lipid control in patients with dyslipidemia. International Standard Randomized Controlled Trial register no. ISRCTN66345533.