Dr. Bates is a consultant and serves on the advisory board for McKesson MedManagement, a company that assists hospitals in preventing adverse drug events. He is on the clinical advisory board for Voltage Inc., which compiles information on compliance for drug companies.
Ambulatory Hypercholesterolemia Management in Patients with Atherosclerosis
Gender and Race Differences in Processes and Outcomes
Article first published online: 21 JAN 2005
Journal of General Internal Medicine
Volume 20, Issue 2, pages 123–130, February 2005
How to Cite
Persell, S. D., Maviglia, S. M., Bates, D. W. and Ayanian, J. Z. (2005), Ambulatory Hypercholesterolemia Management in Patients with Atherosclerosis. Journal of General Internal Medicine, 20: 123–130. doi: 10.1111/j.1525-1497.2005.40155.x
These findings were presented in part at the Society of General Internal Medicine national meeting in Chicago, May 2004.
- Issue published online: 1 APR 2005
- Article first published online: 21 JAN 2005
- Accepted for publication July 1, 2004
- physician's practice patterns;
- coronary disease;
- gender factors;
- African Americans
Objective: To determine whether outpatient cholesterol management varies by gender or race among patients with atherosclerosis, and assess factors related to subsequent cholesterol control.
Design: Retrospective cohort study.
Setting: Primary care clinics affiliated with an academic medical center.
Participants: Two hundred forty-three patients with coronary heart disease, cerebrovascular disease, or peripheral vascular disease and low-density lipoprotein cholesterol (LDL-C)>130 mg/dl.
Measurements And Main Results: The primary process of care assessed for 1,082 office visits was cholesterol management (medication intensification or LDL-C monitoring). Cholesterol management occurred at 31.2% of women's and 38.5% of men's visits (P=.01), and 37.3% of black and 31.7% of white patients' visits (P=.09). Independent predictors of cholesterol management included female gender (adjusted risk ratio [ARR], 0.77; 95% confidence interval [CI], 0.60 to 0.97), seeing a primary care clinician other than the patient's primary care physician (ARR, 0.23; 95% CI, 0.11 to 0.45), and having a new clinical problem addressed (ARR, 0.60; 95% CI, 0.48 to 0.74). After 1 year, LDL-C <130 mg/dl occurred less often for women than men (41% vs 61%; P=.003), black than white patients (39% vs 58%; P=.01), and patients with only Medicare insurance than with commercial insurance (37% vs 58%; P=.008). Adjustment for clinical characteristics and management attenuated the relationship between achieving an LDL-C <130 mg/dl and gender.
Conclusions: In this high-risk population with uncontrolled cholesterol, cholesterol management was less intensive for women than men but similar for black and white patients. Less intense cholesterol management accounted for some of the disparity in cholesterol control between women and men but not between black and white patients.