Goessens B M B, Visseren F L J, Olijhoek J K, Eikelboom B C, van der Graaf Y
Julius Center for Health Sciences and Primary Care, UMC Utrecht, the Netherlands.
Cardiovasc Drugs Ther. 2005 Dec;19(6):429-35. doi: 10.1007/s10557-005-6127-8.
This study investigated whether recommendations given to the treating vascular specialist and the GP by a multidisciplinary team of vascular specialists concerning the medical treatment of risk factors, based on international guidelines, led to an increased medication use in a high-risk population.
Data were obtained from 618 patients enrolled in the SMART study, an ongoing single-center prospective cohort study of patients referred to the University Medical Center Utrecht for atherosclerotic vascular diseases. All patients underwent a vascular screening and their physicians received recommendations concerning the medical treatment of newly detected or not yet sufficiently treated vascular risk factors. After a median follow-up of 29 months, questionnaires about medication use were sent to 618 patients; 534 (86%) questionnaires were returned. Actual use of medication was compared with medical treatment recommendation given at baseline.
The proportion of patients on antihypertensive medication with hypertension (> or =140/90 mmHg) and not diagnosed with coronary heart disease increased from 56% to 68% (95% confidence interval (95% CI) 2 - 23). The frequency of lipid-lowering medication use increased substantially from 47% to 69% (95% CI 17 - 28). The frequency of glucose-lowering medication use increased slightly from 11% to 14% (95% CI 1 - 7). The use of folic acid increased from 2% to 14% (95% CI 9 - 15) in patients with hyperhomocysteinaemia.
Medical treatment recommendations, formulated by a multidisciplinary team, led to a significant increase in medication use. The increase is marginal compared with trends in medication use without this intervention in usual care.
