Effect of physician characteristics and knowledge on the quality of dyslipidemia management and LDL–C target goal achievement in China: Subgroup analysis of the Dyslipidemia International Study

Abstract

ObjectiveThis study aimed to investigate the effect of physicians’ characteristics and knowledge of LDL–C target goals on the quality of lipid management in China.MethodsA total of 25 317 dyslipidemia patients who had taken lipid–lowering medication for >3 months were enrolled in our study. Patients’ demographic data, medical history, lipid profile, their physician’s specialty and professional title and their hospital level as well as their LDL–C goal opinions were recorded.ResultsQuestionnaires were completed by 926 physicians with 6 different specialties and 4 professional statuses, in 3 different–level hospitals. Most (74.5%) of the physicians recognized the importance of considering LDL–C serum concentration for treating dyslipidemia, and set target LDL–C goals according to the 2007 Chinese guidelines for 83.4% of their patients. The LDL–C goal achievement rate was significantly higher for patients whose physicians’ knowledge of LDL–C target goals was consistent with guideline recommendations, compared with those whose physicians’ knowledge was inconsistent with the guidelines (60.4% vs 31.1%, P < 0.0001). Physicians working in tier 1 (odds ration (OR) = 2.95; 95% CI 2.37–3.67), (OR = 1.56; 95% CI 1.34–1.81) and tier 2 (OR = 2.53; 95% CI 2.22–2.88), (OR = 1.16; 95% CI 1.06–1.27) hospitals, specialized in neurology (OR = 1.13; 95% CI 0.93–1.36), (OR = 1.57; 95% CI 1.40–1.77), internal medicine (OR = 1.07; 95% CI 0.90–1.27), (OR = 1.58; 95% CI 1.39–1.80), endocrinology (OR = 1.02; 95% CI 0.87–1.21), (OR = 1.63; 95% CI 1.47–1.82) and being a resident vs attending physician (OR = 1.05; 95% CI 0.92–1.20), (OR = 1.00; 95% CI 1.00–1.19) were independent risk factors for low knowledge of LDL–C target goals and low LDL–C goal achievement.ConclusionChinese physicians’ characteristics and knowledge of LDL–C target goals were associated with patients’ LDL–C goal achievement.

Lipid-lowering therapy use in primary and secondary care in Central and Eastern Europe: DA VINCI observational study

“…These differences among countries in CEE may be because of differences in lifestyle, healthcare systems, socioeconomic factors, varying availability of statins at all doses, special requirements for prescription (e.g., in some of the countries, only specialists can prescribe ezetimibe) and limited reimbursement programmes for LLT. Clinicians play an important role in lipid management [18,19]. When comparing results between different countries, the types of specialists in the participating sites of each country should be considered.…”

Achievement of LDL-C Targets Defined by ESC/EAS (2011) Guidelines in Risk-Stratified Korean Patients with Dyslipidemia Receiving Lipid-Modifying Treatments

“…Late detection of dyslipidemia, inertia in timely and appropriate interventions, as well as presence of other CV comorbidities might also contribute to suboptimal reduction in LDL-C levels. As high physicians’ satisfaction (84.5% in overall) with the current LDL-C levels was revealed to be the prime reason for not prescribing high-intensity or highest dose of statins regardless of either accordance to guidelines recommendation or achieving risk-stratified LDL-C target levels in this study, their physicians’ insufficient of awareness of guidelines might be the major factor of non-adherence to guidelines and, consequently, failure in achieving target LDL-C levels [ 32 – 34 ]. In line with this hypothesis, physicians underestimated the risk levels for 71.6% of all patients in this study and target achievement of LDL-C levels was only 44.3%.…”

Current Status of Low-Density Lipoprotein Cholesterol Target Achievement in Patients with Type 2 Diabetes Mellitus in Korea Compared with Recent Guidelines

“…In a French study, 59% of patients did not reach LDL-C targets, with achievement rates being especially low in the very-high risk group with diabetes [29]. In addition, in a Chinese study, 39.7% of patients in the very-high risk group reached LDL-C treatment targets, which were considered to be related to knowledge about LDL-C targets, physician specialty and professional status such as resident or attending physician [30]. A meta-analysis of guideline target attainment for glucose, blood pressure, and lipid control in patients with diabetes showed an LDL-C treatment target goal achievement of 49.2% (95% confidence interval, 39.0% to 59.4%) of.…”