Rohrer, James E.

ABSTRACT CONTEXT AND OBJECTIVE: To evaluate predictors of changes in lipid parameters consisting of LDL-C (low-density lipoprotein cholesterol), TC (total cholesterol) and non-HDL-C (non-high density lipoprotein cholesterol) among primary care patients. DESIGN AND SETTING: Retrospective study conducted on family medicine patients. METHODS: Demographic features and other clinically relevant information were abstracted from medical records. The primary outcome was the difference in LDL-C level from initial testing to the index test. Secondary outcomes were the changes in TC and non-HDL-C levels between two measurements. RESULTS: Three hundred and eleven participants were included in the final secondary analysis. Multiple linear regression revealed that male patients (β = 4.97, P = 0.040), diabetes (β = 9.75, P = 0.003) and higher LDL-C levels at baseline (β = 0.35, P < 0.001) were positively associated with LDL variance, whereas longer time period (β = -0.15, P = 0.045) and familial hypercholesterolemia history (β = -7.56, P = 0.033) were negatively associated. Male patients (β = 8.45, P = 0.002), DM (β = 9.26, P = 0.011), higher TC levels at baseline (β = 0.35, P < 0.001) and taking statins (β = 7.31, P = 0.023) were positively associated with TC variance, whilst longer time period (β = -0.183, P = 0.031) and familial hypercholesterolemia (β = -10.70, P = 0.008) were negatively associated. CONCLUSION: In the present study, patients who were male, on statin treatment, diagnosed with diabetes and had higher baseline lipid values were more likely associated with better lipid outcomes at future testing.

AbstractRationale, aims and objectivesAlthough the condition of low haemoglobin (Hb) levels has been established as a risk factor in the development of coronary artery disease (CAD), it is still a debate particularly in patients with angiographically documented disease. In the present study, we sought to identify the relationship between Hb levels and the presence of CAD.MethodsThe study consisted of 356 consecutive patients referred for elective coronary angiography (CAG). Exclusion criteria included a history of prior MI within last 3 months, presence of neoplastic disorders or any inflammatory diseases or overt diabetes mellitus. Blood samples for haematologic and biochemical measurements were collected on admission following at least 12 hours of overnight fasting. Patients were divided into four groups based on the quartiles of Hb (quartile I < 13.50 g/dL, quartile II 13.50–14.70 g/dL, quartile III 14.71–15.74 g/dL, quartile IV > 15.74 g/dL). Additionally, patients filled out a questionnaire of asking their brief medical histories and baseline characteristics.ResultsLower Hb quartiles were independently related to the presence of CAD in subjects who were referred to elective CAG. The patients with older age [P = 0.008, odds ratio (OR) = 1.042], male gender (P = 0.007, OR = 3.408), in quartile I (P = 0.003, OR = 5.697), in quartile II (P < 0.001, OR = 8.767), in quartile III (P = 0.011, P = 3.076), higher white blood cells count (P = 0.037, OR = 1.208), lower platelet count (P = 0.049, OR = 0.995), condition of current smoker (P = 0.030, OR = 2.548), higher value of fasting glucose (P = 0.014, OR = 1.038), estimated glomerular filtration rate < 60 (mL/min/1.73 m2; P = 0.004, OR = 3.269) were more likely associated with the risk of the presence of CAD.ConclusionsThe present study revealed that lower quartiles of Hb levels were independently related to the presence of CAD in subjects who were referred to elective CAG. Hb levels, which can be measured easily in almost all medical centres, may be considered as a potential predictor for the presence of CAD in patients at high risk for CAD.

AbstractRationale, aims and objectivesAchieving control over elevated lipid parameters, particularly low‐density lipoprotein (LDL)‐cholesterol, is an acknowledged quality indicator in primary care. The Centers for Disease Control and Prevention (CDC)'s model for investigation of outbreaks (person–place–time) can be applied to the analysis of quality indicators.MethodsA sample of 322 family medicine patients for whom lipid levels were ordered was extracted. LDL > 100 mg/dL was cross‐tabulated by personal characteristics [age group, gender, body mass index (BMI), diagnoses], month (time) and ordering department (place).ResultsAge (except one age category), gender, time and location were not related to LDL > 100 mg/dL after adjustment for covariates. All levels of BMI above normal elevated the risk of LDL > 100 mg/dL [BMI 25–29.9: odds ratio (OR) = 3.41, confidence interval (CI) = 1.61–7.23, P = 0.0014; BMI 30–34.9: OR = 2.93, CI = 1.28–6.70, P = 0.0109; BMI ≥ 35: OR = 2.75, CI = 1.19–6.37, P = 0.0181]. Patients with coronary artery disease (CAD) and diabetes mellitus (DM) were at reduced risk for LDL > 100 mg/dL (CAD: OR = 0.47, CI = 0.24–0.91, P = 0.0254; DM: OR = 0.28, CI = 0.14–0.55, P = 0.0002).ConclusionAn outbreak investigation model is useful for analysing variations in this quality indicator. Patients with higher BMI and those not diagnosed with CAD or DM type I/II may be considered for intensified lipid lowering using quality improvement efforts. These might include counselling for lifestyle changes or medication therapy depending upon their calculated cardiac risk.

AbstractBackgroundThe collaborative care model (CCM) has been consistently shown to achieve effectiveness in depression management compared to usual care. In the present study, we aimed to determine the impact of age on cost metrics in patients who were treated with CCM for 6 months after a diagnosis of depression.MethodsThe upper quartile of age was 50 years and older (n = 56), and the comparison group was composed of patients in the three younger quartiles, aged 18–49 years (n = 163).ResultsPatients in the older age group had an elevated median Current Procedure Terminology cost rank of 255.5 compared to 168.0 for the younger patients (P < 0.001). Multiple logistic regression analysis revealed that being in the upper quartile of age (≥50 years) (odds ratio = 2.272, 95% confidence interval: 1.064–4.851; P = 0.034) and having higher numbers of clinical visits 6 months prior to index (odds ratio = 1.209, 95% confidence interval: 1.118–1.307; P < 0.001) were significant predictor variables of being cost rank outliers (>80th percentile) in patients with CCM.ConclusionMedical cost utilization in the 6 months after diagnosis of depression was significantly higher in patients in the upper age quartile (≥50 years) enrolled in CCM than those in the lower quartiles (age <50).

AbstractRationale, aims and objectivesHypertension (HT) is prevalent in Turkey and even with pharmacological interventions HT control rates do not meet guideline recommendations. We aimed to estimate the proportion of hypertensive patients who achieved target blood pressure (BP) and seek to determine the predictors responsible for failure of to reach goals.MethodsWe conducted a retrospective cohort study involving patients with HT. A total of 437 patients were identified with a current diagnosis of HT at baseline. All available predictors for BP improvements were included in the multivariate linear regression model.ResultsFollow‐up data on HT goal achievements was available for 276 (63.1%) participants. Only 18.1% of the patients at the baseline visit, and 48.6% at the follow‐up visit achieved the overall SBP/DBP targets specified by the JNC‐8 guideline. Significant differences were determined by baseline and 1st visit measurements of mean SBP/DBP levels (P < 0.001, P < 0.001, respectively). DM and baseline SBP were positively associated with SBP improvement (β = 8.410, P = 0.003; β = 0.692, P < 0.001, respectively), whereas being prescribing more HT medications and being older were negatively associated with improvement (β = −7.968, P = 0.005; β = −5.707, P = 0.037; respectively). DM, baseline DBP and HT duration were positively associated with DBP improvement (β = 4.539, P = 0.012; β = 0.702, P < 0.001; β = 0.023, P = 0.012; respectively), whereas additional HT medications and GFR values were negatively associated with improvement (β = −5.682, P = 0.002; β = −0.098, P = 0.005; respectively).ConclusionsAlthough the progress in achieving in BP targets was encouraging, only half of patients had reached the HT goals. Adequate pharmacological approaches and comprehensive management strategies should be implemented in hypertensive patients.

AbstractRationale, aims and objectivesThis study was undertaken to assess the frequency of lipid screening in comparison with the United States Preventive Services Task Force guideline in a sample of family medicine patients. In addition, we sought to determine the association between testing frequency and achievement of lipid targets.MethodsA random sample was extracted from 271 patients from among all patients cared for in our Department of Family Medicine for whom lipid screening was ordered from March to September 2012 and who had ≥2 well‐defined cardiovascular risk factors. Lipid testing frequency was classified in three ways: semi‐annual or less often (0–12 tests over 6 years), annual or less often (0–6 tests), or biennial (0–3 tests).ResultsMultiple logistic regression analysis revealed that the predictors of lipid screening more often than semi‐annually were age ≥60 years [odds ratio (OR) = 3.7] and diabetes mellitus (DM) (OR = 30.6). Predictors of screening more often than annually were DM (OR = 4.3), hypertension (OR = 2.1), family history of premature coronary artery disease (OR = 5.6) and statin treatment (OR = 3.5). Lipid goal attainment was not associated with testing frequency except with regard to low‐density lipoprotein levels (P = 0.043, P < 0.001, P = 0.005, by semi‐annual, annual and biennial, respectively) and total cholesterol levels (P = 0.015, P = 0.025 by semi‐annual and annual, respectively).ConclusionsQuestionable high frequency of lipid testing was detected even when the more conservative approach of annual monitoring was assumed. Frequency of testing was not associated with goal attainment for most parameters. Physicians should request the lipid testing based on overall risk assessment and person variability in accordance with published guidelines.

AbstractRationale, aims and objectivesThe impact of seasonal variation on clinical remission in patients with depression has not been well studied. The hypothesis for this study was that the clinical remission rate would be lower in the winter comparing to the other seasons, specifically evaluated by gender.MethodsThe study cohort comprised 2873 primary care patients with depression as a longitudinal retrospective chart review analysis. The sample was limited to patients who were continuing in care; dropouts were excluded from the analysis.ResultsMultivariate logistic regression analysis of the independent variables for those participants who achieved clinical remission demonstrated that for the male patients, the season of diagnosis did not impact the rate of remission at 6 months while controlling for all other independent variables. For female patients, those that were diagnosed with depression in the fall had increased likelihood of 6‐month remission compared with those patients diagnosed in the winter months (OR 1.300, CI 1.006–1.680, P = 0.045) and the spring and summer patients were not significantly different in their outcome rates. When both genders were combined, the odds of remission at 6 months were not statistically significant for any season of diagnosis.ConclusionsThis study demonstrates that in patients who were continuing care, women who were diagnosed with major depression or dysthymia in the fall season have improved 6‐month clinical outcome of remission compared with those women diagnosed in the winter, when controlling for demographic and clinical characteristics. This effect was not seen in men or when the genders were combined into a single cohort. The assessment of the seasonality effect on depression outcomes requires further long‐term follow‐up studies.