Shaffer J, Wexler L F
Cardiology Section MDP111C2, Department of Veterans Affairs Medical Center, Cincinnati, OH 45220, USA.
Arch Intern Med. 1995 Nov 27;155(21):2330-5.
The Cincinnati (Ohio) Department of Veterans Affairs Medical Center Lipid Clinic was established as a collaborative practice to treat patients with substantially elevated serum cholesterol levels referred from the General Internal Medicine Clinic. The Lipid Clinic team (led by a clinical nurse), included a clinical pharmacist, nurse practitioner, dietitian, and clinical psychologist. A consultant cardiologist reviewed all laboratory tests and confirmed therapeutic decisions at a weekly preclinic meeting.
To compare the success of a limited term of treatment in the Lipid Clinic with that of standard physician-based care in the General Internal Medicine Clinic in achieving the goals recommended by the National Cholesterol Education Program 1 for low-density lipoprotein cholesterol.
A convenience sample of age-matched patients with total cholesterol levels greater than 6.85 mmol/L (265 mg/dL) was selected from each clinic (Lipid Clinic, n = 60; General Internal Medicine Clinic, n = 60). Fasting lipid profiles were drawn in the free-living state and in the sitting position, and matched by month. Treatment of patients in the Lipid Clinic group consisted of evaluation and treatment of secondary causes of hyperlipidemia, goal setting, and treatment according to the National Cholesterol Education Program I algorithm. Counseling and education were individualized. Outcomes were determined after four visits (12 and 18 months for the Lipid Clinic and General Internal Medicine Clinic groups, respectively). Patients in the two groups had comparable risk factors, including presence of coronary heart disease.
After four clinic visits, patients in the Lipid Clinic group were four times more likely to reach a National Cholesterol Education Program I goal of a low-density lipoprotein cholesterol level less than 3.36 mmol/L (130 mg/dL) than were comparable patients in the General Internal Medicine Clinic group (relative risk, 4.1; 95% confidence interval, 1.4 to 12.7; P < .001).
These results support multidisciplinary, goal-oriented collaborative practice as an efficacious model of preventive medicine and health care provision.
俄亥俄州辛辛那提市退伍军人事务部医疗中心脂质诊所是作为一种协作医疗模式设立的，用于治疗从普通内科诊所转诊来的血清胆固醇水平大幅升高的患者。脂质诊所团队（由一名临床护士领导）包括一名临床药剂师、执业护士、营养师和临床心理学家。一名顾问心脏病专家在每周的诊所前会议上审查所有实验室检查结果并确认治疗决策。
比较脂质诊所用时有限的治疗与普通内科诊所基于医生的标准治疗在实现国家胆固醇教育计划1推荐的低密度脂蛋白胆固醇目标方面的成功率。
从每个诊所（脂质诊所，n = 60；普通内科诊所，n = 60）选取年龄匹配、总胆固醇水平大于6.85 mmol/L（265 mg/dL）的便利样本。在自由生活状态下坐姿采集空腹血脂谱，并按月匹配。脂质诊所组患者的治疗包括评估和治疗高脂血症的继发原因、设定目标以及根据国家胆固醇教育计划I算法进行治疗。咨询和教育是个性化的。分别在脂质诊所组和普通内科诊所组进行四次就诊后（分别为12个月和18个月）确定结果。两组患者具有可比的风险因素，包括冠心病的存在。
经过四次诊所就诊后，脂质诊所组患者达到国家胆固醇教育计划I低密度脂蛋白胆固醇水平低于3.36 mmol/L（130 mg/dL）目标的可能性是普通内科诊所组可比患者的四倍（相对风险，4.1；95%置信区间，1.4至12.7；P <.001）。
这些结果支持多学科、以目标为导向的协作医疗模式作为预防医学和医疗保健提供的有效模式。
