A cluster randomized controlled Trial to Evaluate an Ambulatory primary care Management program for patients with dyslipidemia: the TEAM study - 06/08/11
Contributors: Lyne Lalonde, Julie Villeneuve, Jacques Genest, Lucie Blais, Marie-Claude Vanier, Diane Lamarre, Marie-Thérèse Lussier, Sylvie Perreault and Eveline Hudon contributed substantially to the conception and design of the study protocol; Julie Villeneuve and Lyne Lalonde contributed to the acquisition of data; and Julie Villeneuve, Lyne Lalonde, Lucie Blais, Djamal Berbiche and Marc Fredette were responsible for the data analysis. As principal investigator, Lyne Lalonde was responsible for writing the study protocol and this paper, as well as supervising the conduct of the study and the statistical analyses. All of the authors critically revised the article and gave final approval for the version submitted.
Abstract |
Background |
Few studies have reported the efficacy of collaborative care involving family physicians and community pharmacists for patients with dyslipidemia.
Methods |
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.
Results |
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).
Interpretation |
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.
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| Previously published at www.cmaj.ca This article has been peer reviewed. Competing interests: Marie-Thérèse Lussier is the principal investigator for a research project funded by AstraZeneca Canada. She has received educational grants for adaptation and translation of patient communication papers from Merck, AstraZeneca and Sanofi. She received sponsorship from AstraZeneca to attend the European Association for Communication in Health Care (EACH) meeting in September 2008. None declared for all other authors. Funding: This research was funded by a grant from the Canadian Institutes of Health Research(grant number 200409MCT-133732-RCT) and unrestricted research grants from AstraZeneca Canada Inc., Merck Frosst Canada Ltd. and Pfizer Canada Inc. Research scholars Lyne Lalonde, Lucie Blais and Sylvie Perreault received financial support from the Fonds de la recherche en santé du Québec. |
Vol 182 - N° 5
P. 447-455 - mars 2010 Retour au numéro
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