PS3-26: Reasons for Not Achieving Optimal Secondary Prevention Care for Coronary Artery Disease

摘要

>Background and Aims: Adherence to four secondary prevention goals (not using tobacco, LDL measured and <100 mg/dl within one year, blood pressure <140/90 at last visit, and daily aspirin) significantly improves outcomes for patients with coronary artery disease (ICD 9 410–414). However, a significant proportion of patients fail to achieve these four goals. We wished to determine the reasons why patients with CAD failed to achieve care goals in our multispecialty medical group.>Methods: We abstracted 170 randomly-selected records of patients with CAD who failed to achieve care goals.>Results: The two most frequent reasons for failure to achieve care goals were: the care team overlooked care needs at the time of an acute care visit (n=98), and the patient failed to return for follow-up (n=28). Other less frequent reasons were: The patient was offered treatment but declined (n=14); the clinician changed a medication in response to a value that was out of range, and the patient was not yet due for follow-up (n=10); and, the patient was not invited back for follow-up (n=9). The following reasons were observed in only one case each: Co-morbid conditions did not justify aggressive goals; the ordering physician failed to follow-up on a completed test; and, the patient was intolerant of statins. Eight patients failed to meet the optimal CAD care goal for other unique reasons.>Conclusion: Providing clinical care teams with the tools to better track patient care needs (e.g., electronic patient identification and follow-up systems) could significantly reduce secondary prevention care gaps in our medical group.