Authors (including presenting author) :
Hui LC, Chuang YS, Yip PC, Man FY, Choy PS, Chen XRC, Li YC, Ko SH
Affiliation :
Department of Family Medicine and Primary Healthcare (FM&PHC), Kowloon Central Cluster (KCC)
Introduction :
Hyperlipidaemia is an important cardiovascular risk factor. Traditionally, two strategies for the prevention of atherosclerotic cardiovascular disease (ASCVD) are widely recognized: the "high-risk" approach, which identifies individuals at high risk of CVD and targets them for preventive treatment, and the "population" approach, which involves making population-wide changes in risk factors. Current health policy for the prevention of ASCVD primarily emphasizes high-risk strategies over population strategies. This highlights the need to develop a more comprehensive hyperlipidaemia management plan that incorporates both high-risk and population strategies in primary care.
Objectives :
This project aimed to develop a comprehensive hyperlipidaemia management plan to improve lipid management through both high-risk and population strategies.
Methodology :
Study design: retrospectively service review. From year 2023, a series of improvement strategies were implemented to enhance the lipid management in Department of FM & PHC of KCC: 1. Paradigm shift to Dual Pathway approach in hyperlipidaemia management: Cardiovascular risk categories of all GOPC patients were stratified based on medical history and low-density lipoprotein (LDL) targets to guide physicians' management plans including lifestyle modifications and drug treatments. 2. Online Departmental-Wide Staff Engagement: Two online video education talks focusing on ASCVD and hyperlipidaemia were delivered. Short videos highlighting key points were sent to frontline staff to update them on management changes. 3. Widening Drug Use in lipid management: To enhance high-risk group management, newer lipid-lowering agents, including Ezetimibe and Fenofibrate, were introduced into the primary care setting. 4. Quality Assurance and Monitoring: A clinical audit was conducted to review clinicians' performance in lipid management, focusing on high-risk patients with diabetes mellitus (DM) and ASCVD. Data of hyperlipidaemia patients who had been managed in 13 General Out-patient Clinics (GOPCs) of KCC from 01/01/2023 to 31/12/2023 were retrieved from the Clinical Data Analysis and Reporting System (CDARS). The outcomes are latest LDL levels after implementing these actions and the satisfactory lipid control rate defined as LDL <2.6mmol/L among DM patients and <1.8 mmol/L among those with established ASCVD. The Chi-square test was used to examine the statistical significance of changes and P<0.05 is considered as statistically significant.
Result & Outcome :
A total of 127,554 hyperlipidaemia patients managed in 13 GOPCs of KCC were identified in 2023. Among them, 63,293 were diagnosed with Type 2 DM, and 19,374 were diagnosed with ASCVD. After one year of implementing the actions, including lifestyle interventions, risk factor modification strategies, and enhancements in drug treatment, the hyperlipidaemia control rate significantly improved. The satisfactory lipid control rate among DM patients increased from 73.3% to 77.7% (P<0.001). The percentage of hyperlipidaemia control rate among ASCVD patients increased from 45.0% to 52.1% (P<0.001). With the implementation of both a total population risk approach and high-risk strategies, coupled with the adoption of various service enhancements, significant improvements were observed in the management of hyperlipidaemia, particularly among high-risk patients with DM and ASCVD.
