Abstract
Background
Despite American Heart Association recommendations of diet/lifestyle modification
and statin therapy to achieve low-density lipoprotein cholesterol (LDL) control, women
are less likely than men to be screened and achieve treatment goals. This study determined
whether the provider and patient response to electronic medical record (EMR) notification
of an elevated LDL varied by patient sex in veterans.
Methods
Provider responses to EMR clinical reminders for an elevated LDL (≥100 mg/dL) were
assessed in men (n = 40,738) and women (n = 1,025) veterans with ischemic heart disease or diabetes between October 2008 and
September 2009. Responses were classified into four types: 1) Whether the patient
refused medication, 2) the provider ordered or adjusted medication, 3) treatment was
deferred/medications were not changed, or 4) medications were contraindicated. Logistic
regression with generalized estimating equations was used to compare clinical reminder
responses between men and women patients.
Findings
Providers were less likely to order or adjust medications for women (adjusted odds
ratio [OR], 0.75; 95% CI, 0.63, 0.88) and women were more likely than men to refuse
medication (adjusted OR, 1.71; 95% CI, 1.34, 2.17). These associations were not modified
by degree of LDL elevation or use of lipid-lowering medications.
Conclusion
These results indicate that poorer cholesterol control in at risk women is likely
a consequence of both provider and patient factors.
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Biography
Sally G. Haskell, MD, is the Deputy Chief Consultant for Clinical Operations, Women's Health Services, Veterans Health Administration, and an Associate Professor of Medicine Yale School of Medicine. She is a Co-Principal investigator of the VA HSR&D funded Women Veteran's Cohort Study.
Biography
Harini Bathulapalli, MPH, is a biostatistician at the VA Connecticut Healthcare System, where she conducts analysis for the HSR&D funded Women Veterans Cohort Study and the Veteran's Aging Cohort Study.
Biography
Tan Pham, MPH, is Graduate Student in Epidemiology from the University of Massachusetts.
Biography
Dr. Joseph Goulet, PhD, is Assistant Professor of Psychiatry at Yale University, and is director of the methodology and biostatistics core of the VA HSR&D–funded Pain Research, Informatics, Medical Comorbidities, and Education Center (PRIME) at West Haven, Connecticut.
Biography
Melissa Skanderson, MSW, is the chief programmer for the VA HSR&D funded Women Veterans Cohort Study and an expert in National VA data procurement and processing.
Biography
Mary Driscoll, PhD, is an Advanced Fellow in Women's Health at the VA Connecticut Healthcare System.
Biography
Cynthia Brandt, MD, MPH, is a Professor of Emergency Medicine at Yale University, Yale Center for Medical Informatics, and a VA Staff Physician. She Co-Directs the West Haven VA postdoctoral training program in Medical Informatics and is Co-PI of the VA HSR&D funded Women Veteran's Cohort Study.
Biography
James Dziura, PhD, is an Associate Professor of Emergency Medicine at Yale University and the Deputy Director of the Yale Center for Analytical Sciences.
Article info
Publication history
Accepted:
June 9,
2014
Received in revised form:
June 9,
2014
Received:
July 22,
2013
Footnotes
Disclaimer: The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the NIH.
The authors report no financial conflicts of interest.
Financial Support: This research was supported by the VA HSR&D grant #DHI07-065 (Haskell, Brandt) and CTSA Grant Number UL1 RR024139 from the National Center for Research Resources (NCRR) and the National Center for Advancing Translational Sciences (NCATS).
Identification
Copyright
Published by Elsevier Inc.
