MODELS FOR TREATING HIGH BLOOD CHOLESTEROL

为了全面有效地落实《联合国宪章》 国家胆固醇教育项目成人治疗指南， 医生办公室实践中的实施模式必须是 针对成本/效益进行设计、测试和评估。 这项研究旨在比较三种药物的疗效。 分两个阶段实施模式：模式1，以基本办公室为基础 实施(第一阶段)；模式2，办公室协助实施和 模式3，以办公室为基础的基本实施加上包容性 通过社区提供的营养/行为干预 营养中心。实践将在第一阶段后随机分为两个阶段 测试模型2和模型3的条件。模型1将用作 另两个模型的控制组，并将提供信息 关于患者资格、招募模式和应计比率。 干预3个月后的胆固醇反应将是主要的 终点，尽管患者将在第二阶段接受最多两次跟踪 几年来为了确定长期的胆固醇反应， 药物治疗以及药物治疗的效果，并退出 费率。将计算每种模型的成本/效益。 将从30人的小组中招募20名执业医生 在大匹兹堡地区已经确定的做法。每个人 实践将积累至少40名患者，他们将按照 NCEP，ATP指南。这项研究的结果将提供 关于愿意接受治疗的患者数量的重要信息 为了进入治疗，成功降低他们的血液的人数 仅通过饮食方法的胆固醇水平，以及谁会 需要药物治疗和对这种治疗的反应。最后，我们会 能够确定每种方法的成本/效果。

In order to fully and effectively implement the guidelines of the National Cholesterol Education Program's Adult Treatment Guidelines, models for implementation within physicians office practices must be designed, tested, and evaluated for cost/effectiveness. This study has been designed to compare the efficacy of three implementation models in two phases: Model 1, Basic office based implementation (Phase 1); Model 2, Office assisted implementation and Model 3, Basic office based implementation plus an inclusive nutritional/ behavioral intervention offered through a community nutrition center. Practices will be randomized after Phase 1 into two conditions in order to test Models 2 and 3. Model 1 will serve as a control group for the other two models and will also provide information on patient eligibility, recruitment patterns and accrual rates. Cholesterol response after 3 months of intervention will be the primary end-point although patients will be followed in Phase 2 for up to two years in order to determine long-term cholesterol response, patterns of drug therapy as well as effectiveness of drug therapy, and drop out rates. The cost/effectiveness of each of the models will be calculated. Twenty physician practices will be recruited from a group of thirty practices already identified in the greater Pittsburgh area. Each practice will accrue at least 40 patients who will be treated according to the NCEP, ATP guidelines. The results of this study will provide important information as to the number of patients who will be willing to enter therapy, the number who will successfully lower their blood cholesterol levels by dietary approaches alone, and the number who will require drug therapy and the response to this therapy. Finally, we will be able to determine the cost/effectiveness of each approach.