Successful conversion of patients with hypercholesterolemia from a brand name to a generic cholesterol-lowering drug.

OBJECTIVE: To evaluate the safety and effectiveness of a simvastatin-to-lovastatin therapeutic conversion program. STUDY DESIGN: Observational database study of a therapeutic conversion in members of the Northern and Southern California regions of Kaiser Permanente, using a pretest/posttest design. METHODS: All patients actively converted from simvastatin to lovastatin between April 1, 2002, and March 31, 2003, were identified for inclusion in the analysis. The conversion from simvastatin to lovastatin was based on an equipotent dose ratio of 1 mg of simvastatin to 2 mg of lovastatin. Electronic prescription record and laboratory data were collected for converted patients beginning 365 days before changing therapy through June 30, 2003. The primary effectiveness end point was a comparison of the preconversion and postconversion low-density lipoprotein cholesterol (LDL-C) levels. Safety end points included an analysis of preconversion and postconversion alanine aminotransferase (ALT) tests and creatine kinase values. RESULTS: A total of 33,318 converted patients met criteria for inclusion in the analysis. The mean LDL-C was lowered from 110.9 to 108.4 mg/dL (P < .001) following the conversion to lovastatin. The percentage of patients with serum ALT levels greater than 3 times the upper limit of normal (ULN) was similar before (0.7%) and after (0.6%) conversion from simvastatin to lovastatin. Creatine kinase elevations greater then 10 times the ULN occurred at similar rates before and after the conversion. CONCLUSIONS: Overall, patients had an improvement in their lipid profile without evidence of hepatic or muscle enzyme elevations. Appropriately selected patients can be safely and effectively converted from simvastatin to lovastatin.

Point-of-Service reminders for prescribing cardiovascular medications.

OBJECTIVES: To provide physicians with evidence-based recommendations for care at the point of service, using an automated system, and to evaluate its effectiveness in promoting prescriptions to prevent cardiovascular events. STUDY DESIGN: Randomized controlled trial. METHODS: Patients at risk for cardiovascular events who might benefit from angiotensin-converting enzyme inhibitors or 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statins) were identified from electronic data in a managed care organization and randomly assigned into 2 groups. Physicians seeing outpatients in the intervention group were faxed a sheet with pertinent patient data, including a recommendation to prescribe the indicated medication. In the control group, the data sheet did not include the recommendation. Dispensed prescriptions were compared between groups. RESULTS: More than 4000 visits were observed for each medication type. Angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers were dispensed in 7.1% of visits in the intervention group versus 5.7% in the control group (P = .048) following the first patient-physician encounter. No significant difference was observed for statins (intervention, 8.1% vs control, 7.7%). Data for all patient-physician encounters and both medications were combined in logistic regression analysis. The odds ratio was 1.19 for a dispensed prescription in the intervention group and 1.54 for 2 or more visits versus 1 visit. CONCLUSIONS: An automated system that provides pertinent data and tailored recommendations for care at the point of service modestly increased prescription dispensing rates. Targeting patient-provider encounters to change provider behavior is challenging; however, even small effects can produce clinically important results over time.