Use of a parallel clinical advisory service to support lipid lowering in primary care
- Smellie, W Stuart A MA DM MRCP FRCPath
- Robson, Catherine A BSc
Problem
Increasing and unequal referral rates to a lipid and coronary prevention clinic led to demand outstripping resources and long clinic waiting lists.
Design
Clinical and laboratory interventions to support primary care and change delivery of outpatient lipid services including introduction of separate clinical advisory service for general practices. Measurement of referral patterns and patient results before and after interventions.
Background and setting
Lipid and coronary prevention clinic and two hospital clinical laboratories serving 34 practices, covering approximately 290 000 patients in South Durham.
Key measurements for improvement
Reduction in clinic waiting list, changes in clinical referral patterns, quantitative changes in serum cholesterol and triglyceride concentrations before and 6–12 months after advice.
Strategies for change
Clinical advisory service to general practitioners operating in parallel with the outpatient clinic. Laboratory computer-based interpretative advice on lipid testing had been introduced previously to support primary care.
Effects of change
Waiting times fell from 35 weeks to one to two weeks, standardised referral patterns changed, the advisory service dealt with 60% of potential referrals. Average serum cholesterol concentrations in patients managed on advice alone fell by 23% and triglycerides by 41%.
Lessons learnt
Alternative approaches to outpatient management of cholesterol lowering can help to reduce waiting times, change inequalities in referral patterns and support successful improvements in serum lipid results. This approach may be of use in other targeted clinical situations.