31707c2d8146b2e39598a72d8a4cf751 pmc_33228008.pdf 1f0e575e502e9588079c4923f443fae14ab93248 pmc_33228008.pdf ada8a6bd0fd867ecd6345e7899dc3e09561632625e3577e9784db7a3cbc67a3c pmc_33228008.pdf Title: Impact of Implementing a Dyslipidemia Management Guideline on Cholesterol Control for Secondary Prevention of Ischemic Heart Disease in Primary Care Subject: Cardiovascular diseases (CVD) are the main cause of death worldwide. The control of CVD risk factors, such as dyslipidemia, reduces their mortality rate. Nonetheless, fewer than 50% of patients with ischemic heart disease (IHD) have good cholesterol control. Our objective is to assess whether the level of participation of general practitioners (GPs) in activities to implement a dyslipidemia management guideline, and the characteristics of the patient and physician are associated with cholesterol control in IHD patients. We undertook a quasi-experimental, uncontrolled, before-and-after study of 1151 patients. The intervention was carried out during 2010 and 2011, and consisted of a face-to-face training and online course phase (Phase 1), and another of face-to-face feedback (Phase 2). The main outcome variable was the low-density lipoprotein cholesterol (LDL-C) control, whereby values of <100 mg/dL (2.6 mmol/L) were set as a good level of control, according to the recommendations of the guidelines in force in 2009. After Phase 1, 6.7% more patients demonstrated good cholesterol control. With respect to patient characteristics, being female and being older were found to be risk factors of poor control. Being diabetic and having suffered a stroke were protective factors. Of the GPs’ characteristics, being tutor in a teaching center for GP residents and having completed the online course were found to be protective factors. We concluded that cholesterol control in IHD patients was influenced by the type of training activity undertook by physicians during the implementation of the GPC, and patient and physician characteristics. We highlight that if we apply the recent targets of the European guideline, which establish a lower level of LDL-C control, the percentage of good control could be worse than the observed in this study. Keywords: practice guideline; cholesterol; secondary prevention; ischemic heart disease; primary health care Author: Emma Forcadell Drago, Maria Rosa Dalmau Llorca, Carina Aguilar Martín, Ignacio Ferreira-González, Zojaina Hernández Rojas, Alessandra Queiroga Gonçalves and Carlos López-Pablo Creator: LaTeX with hyperref package Producer: pdfTeX-1.40.19 CreationDate: Thu Nov 19 09:48:19 2020 CET ModDate: Thu Nov 19 09:48:19 2020 CET Tagged: no UserProperties: no Suspects: no Form: none JavaScript: no Pages: 15 Encrypted: no Page size: 595.276 x 841.89 pts (A4) Page rot: 0 File size: 363047 bytes Optimized: no PDF version: 1.5 name type encoding emb sub uni object ID ------------------------------------ ----------------- ---------------- --- --- --- --------- LYWYBZ+URWPalladioL-Ital Type 1 Custom yes yes no 85 0 HXVWLR+URWPalladioL-Bold Type 1 Custom yes yes no 86 0 QTLELQ+Pxbsy Type 1 Builtin yes yes no 87 0 PRJKGQ+VnURWPalladioL-Bold Type 1 Custom yes yes no 88 0 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こぴふつべぜ〴ぜ〰いづびどでのぜ〴ぜ〰ちのつぜ〴ぜ〰ぐちひぴどっどばちのぴびぜ〴〩਼㰠⽓ 䝯呯 䐠⡳畢獥捴楯渮㈮㈩‾㸊⡜㌷㙜㌷㝜〰こちねばぬづぜ〴ぜ〰こどぺづぜ〴ぜ〰ちのつぜ〴ぜ〰ぐちぴどづのぴぜ〴ぜ〰こづぬづっぴどはのぜ〴〩਼㰠⽓ 䝯呯 䐠⡳畢獥捴楯渮㈮㌩‾㸊⡜㌷㙜㌷㝜〰いちぴちぜ〴ぜ〰ぃはぬぬづっぴどはのぜ〴〩਼㰠⽓ 䝯呯 䐠⡳畢獥捴楯渮㈮㐩‾㸊⡜㌷㙜㌷㝜〰ざちひどちぢぬづびぜ〴〩਼㰠⽓ 䝯呯 䐠⡳畢獥捴楯渮㈮㔩‾㸊⡜㌷㙜㌷㝜〰ぉのぴづひぶづのぴどはのぜ〴〩਼㰠⽓ 䝯呯 䐠⡳畢獥捴楯渮㈮㘩‾㸊⡜㌷㙜㌷㝜〰こぴちぴどびぴどっちぬぜ〴ぜ〰ぁのちぬべびどびぜ〴〩਼㰠⽓ 䝯呯 䐠⡳畢獥捴楯渮㈮㜩‾㸊⡜㌷㙜㌷㝜〰ぅぴとどっびぜ〴〩਼㰠⽓ 䝯呯 䐠⡳散瑩潮⸳ Item: Title: こちねばぬづぜ〴ぜ〰こどぺづぜ〴ぜ〰ちのつぜ〴ぜ〰ぐちぴどづのぴぜ〴ぜ〰こづぬづっぴどはのぜ〴〩਼㰠⽓ 䝯呯 䐠⡳畢獥捴楯渮㈮㌩‾㸊⡜㌷㙜㌷㝜〰いちぴちぜ〴ぜ〰ぃはぬぬづっぴどはのぜ〴〩਼㰠⽓ 䝯呯 䐠⡳畢獥捴楯渮㈮㐩‾㸊⡜㌷㙜㌷㝜〰ざちひどちぢぬづびぜ〴〩਼㰠⽓ 䝯呯 䐠⡳畢獥捴楯渮㈮㔩‾㸊⡜㌷㙜㌷㝜〰ぉのぴづひぶづのぴどはのぜ〴〩਼㰠⽓ 䝯呯 䐠⡳畢獥捴楯渮㈮㘩‾㸊⡜㌷㙜㌷㝜〰こぴちぴどびぴどっちぬぜ〴ぜ〰ぁのちぬべびどびぜ〴〩਼㰠⽓ 䝯呯 䐠⡳畢獥捴楯渮㈮㜩‾㸊⡜㌷㙜㌷㝜〰ぅぴとどっびぜ〴〩਼㰠⽓ 䝯呯 䐠⡳散瑩潮⸳ Item: Title: いちぴちぜ〴ぜ〰ぃはぬぬづっぴどはのぜ〴〩਼㰠⽓ 䝯呯 䐠⡳畢獥捴楯渮㈮㐩‾㸊⡜㌷㙜㌷㝜〰ざちひどちぢぬづびぜ〴〩਼㰠⽓ 䝯呯 䐠⡳畢獥捴楯渮㈮㔩‾㸊⡜㌷㙜㌷㝜〰ぉのぴづひぶづのぴどはのぜ〴〩਼㰠⽓ 䝯呯 䐠⡳畢獥捴楯渮㈮㘩‾㸊⡜㌷㙜㌷㝜〰こぴちぴどびぴどっちぬぜ〴ぜ〰ぁのちぬべびどびぜ〴〩਼㰠⽓ 䝯呯 䐠⡳畢獥捴楯渮㈮㜩‾㸊⡜㌷㙜㌷㝜〰ぅぴとどっびぜ〴〩਼㰠⽓ 䝯呯 䐠⡳散瑩潮⸳ Item: Title: ざちひどちぢぬづびぜ〴〩਼㰠⽓ 䝯呯 䐠⡳畢獥捴楯渮㈮㔩‾㸊⡜㌷㙜㌷㝜〰ぉのぴづひぶづのぴどはのぜ〴〩਼㰠⽓ 䝯呯 䐠⡳畢獥捴楯渮㈮㘩‾㸊⡜㌷㙜㌷㝜〰こぴちぴどびぴどっちぬぜ〴ぜ〰ぁのちぬべびどびぜ〴〩਼㰠⽓ 䝯呯 䐠⡳畢獥捴楯渮㈮㜩‾㸊⡜㌷㙜㌷㝜〰ぅぴとどっびぜ〴〩਼㰠⽓ 䝯呯 䐠⡳散瑩潮⸳ Item: Title: ぉのぴづひぶづのぴどはのぜ〴〩਼㰠⽓ 䝯呯 䐠⡳畢獥捴楯渮㈮㘩‾㸊⡜㌷㙜㌷㝜〰こぴちぴどびぴどっちぬぜ〴ぜ〰ぁのちぬべびどびぜ〴〩਼㰠⽓ 䝯呯 䐠⡳畢獥捴楯渮㈮㜩‾㸊⡜㌷㙜㌷㝜〰ぅぴとどっびぜ〴〩਼㰠⽓ 䝯呯 䐠⡳散瑩潮⸳ Item: Title: こぴちぴどびぴどっちぬぜ〴ぜ〰ぁのちぬべびどびぜ〴〩਼㰠⽓ 䝯呯 䐠⡳畢獥捴楯渮㈮㜩‾㸊⡜㌷㙜㌷㝜〰ぅぴとどっびぜ〴〩਼㰠⽓ 䝯呯 䐠⡳散瑩潮⸳ Item: Title: ぅぴとどっびぜ〴〩਼㰠⽓ 䝯呯 䐠⡳散瑩潮⸳ Item: Title: げづびふぬぴびぜ〴〩਼㰠⽓ 䝯呯 䐠⡳畢獥捴楯渮㌮ㄩ‾㸊⡜㌷㙜㌷㝜〰ぃとちのでづびぜ〴ぜ〰くぢびづひぶづつぜ〴ぜ〰どのぜ〴ぜ〰がいが〭ぃぜ〴ぜ〰ぃはのぴひはぬぜ〴ぜ〰ちてぴづひぜ〴ぜ〰ぉねばぬづねづのぴどのでぜ〴ぜ〰ぴとづぜ〴ぜ〰ぃぐぇぜ〴〩਼㰠⽓ 䝯呯 䐠⡳畢獥捴楯渮㌮㈩‾㸊⡜㌷㙜㌷㝜〰うづちぴふひづびぜ〴ぜ〰ぁびびはっどちぴづつぜ〴ぜ〰ぷどぴとぜ〴ぜ〰がいが〭ぃぜ〴ぜ〰ぃはのぴひはぬぜ〴ぜ〰ちてぴづひぜ〴ぜ〰ぐとちびづぜ〴ぜ〰〱ぜ〴〩਼㰠⽓ 䝯呯 䐠⡳畢獥捴楯渮㌮㌩‾㸊⡜㌷㙜㌷㝜〰うちっぴはひびぜ〴ぜ〰ぁびびはっどちぴづつぜ〴ぜ〰ぷどぴとぜ〴ぜ〰ぴとづぜ〴ぜ〰ぃはのぴひはぬぜ〴ぜ〰はてぜ〴ぜ〰がいが〭ぃぜ〴ぜ〰ちてぴづひぜ〴ぜ〰ぐとちびづぜ〴ぜ〰〲ぜ〴〩਼㰠⽓ 䝯呯 䐠⡳散瑩潮⸴ Children: Item: Title: ぃとちのでづびぜ〴ぜ〰くぢびづひぶづつぜ〴ぜ〰どのぜ〴ぜ〰がいが〭ぃぜ〴ぜ〰ぃはのぴひはぬぜ〴ぜ〰ちてぴづひぜ〴ぜ〰ぉねばぬづねづのぴどのでぜ〴ぜ〰ぴとづぜ〴ぜ〰ぃぐぇぜ〴〩਼㰠⽓ 䝯呯 䐠⡳畢獥捴楯渮㌮㈩‾㸊⡜㌷㙜㌷㝜〰うづちぴふひづびぜ〴ぜ〰ぁびびはっどちぴづつぜ〴ぜ〰ぷどぴとぜ〴ぜ〰がいが〭ぃぜ〴ぜ〰ぃはのぴひはぬぜ〴ぜ〰ちてぴづひぜ〴ぜ〰ぐとちびづぜ〴ぜ〰〱ぜ〴〩਼㰠⽓ 䝯呯 䐠⡳畢獥捴楯渮㌮㌩‾㸊⡜㌷㙜㌷㝜〰うちっぴはひびぜ〴ぜ〰ぁびびはっどちぴづつぜ〴ぜ〰ぷどぴとぜ〴ぜ〰ぴとづぜ〴ぜ〰ぃはのぴひはぬぜ〴ぜ〰はてぜ〴ぜ〰がいが〭ぃぜ〴ぜ〰ちてぴづひぜ〴ぜ〰ぐとちびづぜ〴ぜ〰〲ぜ〴〩਼㰠⽓ 䝯呯 䐠⡳散瑩潮⸴ Item: Title: うづちぴふひづびぜ〴ぜ〰ぁびびはっどちぴづつぜ〴ぜ〰ぷどぴとぜ〴ぜ〰がいが〭ぃぜ〴ぜ〰ぃはのぴひはぬぜ〴ぜ〰ちてぴづひぜ〴ぜ〰ぐとちびづぜ〴ぜ〰〱ぜ〴〩਼㰠⽓ 䝯呯 䐠⡳畢獥捴楯渮㌮㌩‾㸊⡜㌷㙜㌷㝜〰うちっぴはひびぜ〴ぜ〰ぁびびはっどちぴづつぜ〴ぜ〰ぷどぴとぜ〴ぜ〰ぴとづぜ〴ぜ〰ぃはのぴひはぬぜ〴ぜ〰はてぜ〴ぜ〰がいが〭ぃぜ〴ぜ〰ちてぴづひぜ〴ぜ〰ぐとちびづぜ〴ぜ〰〲ぜ〴〩਼㰠⽓ 䝯呯 䐠⡳散瑩潮⸴ Item: Title: うちっぴはひびぜ〴ぜ〰ぁびびはっどちぴづつぜ〴ぜ〰ぷどぴとぜ〴ぜ〰ぴとづぜ〴ぜ〰ぃはのぴひはぬぜ〴ぜ〰はてぜ〴ぜ〰がいが〭ぃぜ〴ぜ〰ちてぴづひぜ〴ぜ〰ぐとちびづぜ〴ぜ〰〲ぜ〴〩਼㰠⽓ 䝯呯 䐠⡳散瑩潮⸴ Item: Title: いどびっふびびどはのぜ〴〩਼㰠⽓ 䝯呯 䐠⡳散瑩潮⸵ Item: Title: ぃはのっぬふびどはのびぜ〴〩਼㰠⽓ 䝯呯 䐠⡳散瑩潮⸵ Item: Title: げづてづひづのっづび Filters: FilterPipeline: FlateDecode Fonts: Type1: Font: BaseFont: QLBIEB+URWPalladioL-BoldItal FontSubset: true FirstChar: 110 LastChar: 112 FontDescriptor: FontName: QLBIEB+URWPalladioL-BoldItal Flags: Symbolic FontBBox: -170, -300, 1073, 935 FontFile: true EncodingDictionary: Differences: true Font: BaseFont: VSHNAE+Rpcxr FontSubset: true FirstChar: 169 LastChar: 169 FontDescriptor: FontName: VSHNAE+Rpcxr Flags: Symbolic FontBBox: -212, -286, 1344, 973 FontFile: true Font: BaseFont: MFIGJL+Rpxb FontSubset: true FirstChar: 47 LastChar: 47 FontDescriptor: FontName: 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