Evaluation of a multidisciplinary lipid clinic to improve the care of individuals with severe lipid conditions: a RE-AIM framework analysis

Abstract

Background Individuals with complex dyslipidemia, or those with medication intolerance, are often difficult to manage in primary care. They require the additional attention, expertise, and adherence counseling that occurs in multidisciplinary lipid clinics (MDLCs). We conducted a program evaluation of the first year of a newly implemented MDLC utilizing the RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) framework to provide empirical data not only on program effectiveness, but also on components important to local sustainability and future generalizability. Methods The purpose of the MDLC is to increase the uptake of guideline-based care for lipid conditions. Established in 2019, the MDLC provides care via a centralized clinic location within the healthcare system. Primary care providers and cardiologists were invited to refer individuals with lipid conditions. Using a pre/post-study design, we evaluated the implementation outcomes from the MDLC using the RE-AIM framework. Results In 2019, 420 referrals were made to the MDLC (reach). Referrals were made by 19% (148) of the 796 active cardiology and primary care providers, with an average of 35 patient referrals per month in 2019 (SD 12) (adoption). The MDLC saw 83 patients in 2019 (reach). Additionally, 50% (41/82) had at least one follow-up MDLC visit, and 12% (10/82) had two or more follow-up visits in 2019 (implementation). In patients seen by the MDLC, we found an improved diagnosis of specific lipid conditions (FH (familial hypercholesterolemia), hypertriglyceridemia, and dyslipidemia), increased prescribing of evidence-based therapies, high rates of medication prior authorization approvals, and significant reductions in lipid levels by lipid condition subgroup (effectiveness). Over time, the operations team decided to transition from in-person follow-up to telehealth appointments to increase capacity and sustain the clinic (maintenance). Conclusions Despite limited reach and adoption of the MDLC, we found a large intervention effect that included improved diagnosis, increased prescribing of guideline-recommended treatments, and clinically significant reduction of lipid levels. Attention to factors including solutions to decrease the large burden of unseen referrals, discussion of the appropriate number and duration of visits, and sustainability of the clinic model could aid in enhancing the success of the MDLC and improving outcomes for more patients throughout the system.

Impact of a Population Genomic Screening Program on Health Behaviors Related to Familial Hypercholesterolemia Risk Reduction

“… 30 However, when pre- and postdisclosure genetic counseling was integrated into a multidisciplinary lipid clinic for FH at Geisinger, almost all participants opted for the visit. 25 One potential reason for lower uptake of genetic counseling in this study could be the requirement of scheduling and completing an additional visit, supporting the integration of genetic counseling services into other specialty care. Use of chronic medications, such as lipid-lowering therapies, can be difficult for participants to initiate and sustain.…”

“…23 Clinician and patient knowledge related to FH impacts care from identification to treatment. [24][25][26][27] Once identified, access to treatment can be difficult. Low prescribing of PCSK9 inhibitors due to access problems is consistent with a large cohort study conducted by the Family Heart Foundation (previously the FH Foundation).…”

Awareness and knowledge of heterozygous familial hypercholesterolemia among Serbian pediatricians

“…Hence, timely detection, early and adequate treatment of patients suffering from FH, are essential in preventing cardiovascular events later in life ( 8 ). However, absence of the lipid clinics, national registries and initiatives on screening for FH in many countries worldwide, including Serbia, indicate important shortcomings of healthcare and medical education institutions which are directly and reciprocally linked ( 9 ).…”

How Can Implementation Science Improve the Care of Familial Hypercholesterolaemia?

“…Some suggested solutions included patient and clinician education, transparency of data to the patient, peer groups and clinician champions [ 60 ]. One of these solutions, the creation of a new clinical team, creation of a multidisciplinary lipid clinic, was piloted and a program evaluation of its first-year post-implementation found improved diagnosis of FH, increased prescribing of evidence-based therapies and significant reductions in lipid levels [ 41 ].…”