A 2018/2019 Summer Studentship research project
Laboratory testing incurs costs to the health system and to the individuals who are tested. The individual must find time for their blood sample to be taken and then to discuss the result of the test with their care provider. For the system, there is a direct cost of taking a patient’s blood sample, transporting it to the laboratory, and analyzing the sample; following this a clinician must allocate time to review the test result and communicate the result and subsequent management plan to the patient. Our results may point to areas where care could be rationalized or improved with consequent savings for patients and the health system.
Student: Harrison Beadel
Supervisors: Dr Ben Hudson, Paul Bridgford
Sponsor: Pegasus Health (Charitable) Limited
Project brief
Introduction
Cardiovascular disease (CVD) remains an important cause of mortality and morbidity in New Zealand, and CVD risk (CVDR) management is a national priority for primary care. Measurement of patients’ lipid profiles is a core component of assessing CVDR and lipid profiles are amongst the most frequently requested community blood tests in Canterbury.
Strong evidence supports the use of statins in primary and secondary prevention of CVDR and these drugs are widely used. In 2016 in New Zealand, 1.1 million prescriptions were issued for atorvastatin alone, putting this drug fifth on the list of the country’s most commonly prescribed medicines.
The optimal approach to lipid monitoring for patients prescribed statins is still controversial: the current New Zealand CVDR guidance promotes regular monitoring and dose adjustment following stating initiation, whereas US guidelines advocate a risk-based dose selection following which lipid measurement is not recommended.
There is little evidence about how primary care practitioners in New Zealand approach lipid monitoring in patients taking statins. A recent US study found that amongst patients taking a statin, lipid testing only rarely results in alteration in treatment. This raises important questions about the clinical value and cost effectiveness of monitoring.
Aim
To describe patterns of community lipid testing and subsequent therapeutic alteration in patients established on statin therapy.
Method
We propose a cross-sectional study of statin dispensing before and after lipid measurement in patients established on statin therapy. We will compare statin use (type and dose dispensed) before and after lipid measurement.
We will first identify all patients within Pegasus PHO who were dispensed a statin in a 6-month period.
For all identified patients, we will record the number and date of lipid profile tests performed in the 12-month period following their most recent statin dispensing.
For each patient who had a lipid profile test, we will record the statin type and dose dispensed within 6 months of the test date.
Student researcher’s component of the study
The student will assist with data cleaning and initial analysis. This work will be supported by Paul Bridgford, data analyst and project co-supervisor.
