Eid Wael E, Sapp Emma Hatfield, Conroy Callen, Bessinger Coby, Moody Cassidy L, Yadav Ryan, Tolliver Reece, Nolan Joseph, Francis Suzanne M
St. Elizabeth Physicians Regional Diabetes Center, Covington, Kentucky, USA.
University of Kentucky College of Medicine, Lexington, Kentucky, USA.
Am J Prev Cardiol. 2024 Nov 23;21:100895. doi: 10.1016/j.ajpc.2024.100895. eCollection 2025 Mar.
Lipoprotein(a) [Lp(a)] is a low-density lipoprotein variant with atherogenic, thrombogenic, and pro-inflammatory properties that may have numerous pathologic effects, including dyslipidemia. Screening for Lp(a) is clinically significant, due to its causal role in atherosclerotic cardiovascular disease (ASCVD). Among clinicians, however, there remains a general lack of both clinical awareness of Lp(a) and adequate tools to track Lp(a) testing in patients.
To study factors affecting Lp(a) screening by: i) determining the effectiveness of messaging providers at a large community health system about Lp(a) screening and measuring the subsequent percentage of Lp(a) tests requested; and ii) by determining the percentage of patients who obtained Lp(a) testing after being advised by the provider.
From December 2022 through March 2023, messages detailing the need for Lp(a) screening were sent via the Epic EHR™ to providers of patients meeting criteria for Lp(a) testing in advance of scheduled patient appointments. In this prospective study, providers were randomized into 2 groups: those receiving the pre-appointment message (Group 1) and those not receiving the pre-appointment message (Group 2).
Sending pre-appointment messages correlated with more Lp(a) orders (16.6 % v. 4.7 %, < 0.001) and consequently with more tests performed (10.2 % v. 3.7 %, < 0.001). Among provider types, nurse practitioners and physician assistants had the highest number of Lp(a) results per order ( = 16.40, < 0.001), achieving 30.8-39.1 % more test results, even if they did not receive the pre-appointment message. Distribution of Lp(a) values in patients was 59.7 % ≤ 29 mg/dL; 9.7 % > 29 and < 50mg/dL; and 30.6 % ≥ 50 mg/dL.
Providers who received pre-appointment messages via an EHR were associated with requesting more tests and consequently receiving more Lp(a) results, compared with providers who did not receive messages.
脂蛋白(a)[Lp(a)]是一种具有致动脉粥样硬化、致血栓形成和促炎特性的低密度脂蛋白变体，可能具有多种病理作用，包括血脂异常。由于Lp(a)在动脉粥样硬化性心血管疾病(ASCVD)中起因果作用，因此对其进行筛查具有临床意义。然而，在临床医生中，对Lp(a)的临床认识普遍不足，且缺乏足够的工具来跟踪患者的Lp(a)检测情况。
通过以下方式研究影响Lp(a)筛查的因素：i)确定大型社区卫生系统中信息提供者关于Lp(a)筛查的有效性，并测量随后要求进行Lp(a)检测的百分比；ii)确定在提供者建议后进行Lp(a)检测的患者百分比。
从2022年12月到2023年3月，在预定患者预约前，通过Epic EHR™向符合Lp(a)检测标准患者的提供者发送详细说明Lp(a)筛查必要性的信息。在这项前瞻性研究中，提供者被随机分为两组：收到预约前信息的组(第1组)和未收到预约前信息的组(第2组)。
发送预约前信息与更多的Lp(a)检测医嘱相关(16.6%对4.7%，<0.001)，因此与更多的检测执行相关(10.2%对3.7%，<0.001)。在不同类型的提供者中，执业护士和医师助理每份医嘱的Lp(a)检测结果数量最多(=16.40，<0.001)，即使他们没有收到预约前信息，检测结果也多出30.8%-39.1%。患者中Lp(a)值的分布为：59.7%≤29mg/dL；9.7%>29且<50mg/dL；30.6%≥50mg/dL。
与未收到信息的提供者相比，通过电子健康记录收到预约前信息的提供者与要求进行更多检测以及因此获得更多Lp(a)检测结果相关。
