Abstract 306: Evaluation of The Effectiveness of Disease Management Programs Physician Directed Communications in a General Cardiology Practice

Abstract

BACKGROUND: Disease management programs (DMP) issue frequent physician directed communications (PDC) to cardiology practices with the objective to assist the practitioners using an evidence-based approach. Although PDC have become widespread, the usefulness of this intervention in Cardiology is unknown. The objective of this study is to evaluate the effectiveness of established cardiology DMP-PDC in a general community cardiology practice. METHODS: A prospective cohort study evaluating all DMP-PDC received in a general cardiology practice from 6/2011 to 12/2012 was completed. The study included three fellowship trained board-certified cardiologist that examined the usefulness of DMP-PDC using a standardized questionnaire. Demographic data, pharmacological profile, type of DMP, general appropriateness based on current ACC/AHA guidelines, patient individual appropriateness, inappropriate recommendations and whether the DMP-PDC was effectively implemented in clinical practice was examined. RESULTS: 188 consecutive DMP-PDC were evaluated. Demographic characteristics (60% males / mean age: 67±13 Yr) of the cohort were as expected for a general cardiology practice. Recommendations were available from different DMP [Medco (30.3%), CVS Caremark (25.5%), Aetna Active (25.5%), United Healthcare (8.5%) and other (10.2%)]. 152 (81%) DMP-PDC were appropriate in the general clinical context but not implemented based on individualized appropriateness criteria: 35 (19%) directed to the wrong physician, 39 (21%) already implemented prior to the DMP-PDC, 45 (24%) considered to add no clinical benefit based on individual appropriateness, 14 (7%) based on outdated evidence-based information, 7 (4%) implemented in practice without success prior to the DMP-PDC, 5 (3%) directed to patients not in the practice, and 7 (4%) for other reasons. 28 (15%) DMP-PDC were inappropriate: 9 (5%) due to an incorrect patient diagnosis, 2 (1%) due to intolerance to the intervention proposed, 2 (1%) due to a pharmacological interactions with other medications, 7 (4%) due to compliance related-issues and 8 (5%) were DMP-PDC based on incorrect medications. Among all recommendations reviewed, only 15 (8%) were actually effectively applied in clinical practice. CONCLUSION: DMP-PDC can be useful in formulating general patient evidence-base recommendations, but are ineffective tools in clinical practice due to individual patient related factors that prevent implementation, and thus; unlikely to translate in improvement in health care delivery.