The overall goal of this proposal is to develop and evaluate as to feasibility and impact a rural lipid resource center as a practical care model which will assist health care providers in rural, relatively isolated primary practice settings to become more effective in the detection, evaluation, and treatment of patients with hypercholesterolemia according to Adult Treatment Panel guidelines. This proposal takes advantage of the system of 14 outreach Centers of The Mary Imogene Bassett Hospital. These centers are solo or small group primary care practices located in small towns or villages overr a vast, medically underserved rural area (approximately 80 miles by 80 miles). The 14 centers will be randomly allocated to a usual care group (N=7, 15 care providers) and a group assisted by the Lipid Resource Center (LRC) with four types of intervention (N=7, 15 care providers). First, the LRC group will receive weekly feedback from a central , CDC-standardized laboratory as to the patients identified with borderline high or high cholesterol levels, as well as recommendations for follow-up care. Second, patients from each care provider will be referred to the LRC nutritionist, who will send the patient by mail literacy-independent instructional material, featuring an 8-week course on a VCR to be followed at home or at a local resource, supported by telephone consultation. Third, patients who do not meet blood cholesterol goals after a Step I diet will be seen by the LRC nutritionist for a Step II diet. Fourth, patients not meeting goals after Step II diet will be identified for the care provider and a list of medications, recommendations for followup for side effects and compliance-raising strategies will be sent to the care provider. Program evaluation will be done by a multidisciplinary team and include baseline and final audits of the care providers' medical records, and knowledge and attitude surveys of the providers in both groups. The usual care and LRC groups will be evaluated as to % placed on appropriate drug) and outcome (change in % of total calories as fat and saturated fat, milligrams of dietary cholesterol, mg/di reduction in LDL cholesterol levels, and cost of intervention). The model, if shown effective, should be generalizable to many rural practices, health maintenance organizations, regional medical centers, and teaching hospitals,
| Pearson, T A; Peters, T D (1997) The treatment gap in coronary artery disease and heart failure: community standards and the post-discharge patient. Am J Cardiol 80:45H-52H |
