Toolkit for Implementing the Chronic Care Model in an Academic Environment: Residents, Staff, and Patients Working as a Team

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Toolkit for Implementing the Chronic Care Model in an Academic Environment

Lipid Lowering Therapy Algorithm for Hypertension (Text Description)

The Lipid Lowering Therapy Algorithm begins with a text box that reads:

Assess Lipid Panel

Goals:
LDL <100 if no CAD
LDL <70 uf PVD or CAD
Triglycerides (TG) <150

Three arrows lead from it. The one to the left is labeled "Lipids at goal and no meds" and points to a box that reads:

Recheck in 1 year

The arrow in the center is labeled "Lipids at goal and on meds" and points to a box that reads:

Recheck in 3-6 months

The arrow to the right is labeled "Lipids not at goal and on meds" and points to a box that reads:

Get a current lipid panel if last panel >6 months if there have been no recent pharmacy changes.

Get a current lipid panel if last panel >6 weeks with recent pharmacy changes.

Assess lipid lowering medicines, review previous allergy or intolerance to lipid lowering medicines and advise on lifestyle changes.

Determine Primary Target:

Two arrows lead from this box to two boxes below it. The box to the left reads:

If TG <400 and LDL is not at goal
—LDL is the target

1st option—statin at 25 to 50 % of maximal dose
Reassess LFTs, lipids at 6 wks and reclassify patient

2nd option—statin to maximal dose and reassess LFTs, lipids at 6 wks and reclassify patient

3rd LDL option—choice binding agent/Zetia or nicotinic acid and reassess LFTs, lipids at 6 wks and reclassify patient.

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When patient is at goal recheck in 3-6 months

The box to the right reads:

If TG 151-400 but LDL is at goal—TG is the target
Or /
If TG >400—Then TG is the target

1st option—Lopid 600 twice daily Or/
Tricor 54-145 daily depending on degree of TG elevation
Reassess and Reclassify according to levels at 6 weeks (lipids, liver profile)

Still in TG Group ?

2nd TG option—Statin 25 to 50 % of maximal dose
Reassess LFTs, lipids and reclassify patient

3rd TG option—increase statin to maximal dose
Reassess and reclassify according to levels at 6 weeks (lipids, liver profile)

4th TG option—omega 3 FA or nicotinic acid and work up to maximal dose
Reassess and Reclassify according to levels at 6 weeks (lipids, liver profile)

5th TG option—omega 3 FA or nicotinic acid (depending on what was added) and work up to maximal dose

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When patient is at goal recheck in 3-6 months

A note at the bottom of the algorithm reads:

Note:

Whenever a patient is put on a new lipid lowering medicine and adjust medication they should be contacted in 1 week to assess tolerance and adherence. Consultation with endocrinologist is an option at any point along the pathway.
Whenever medication is changed or added, recheck lipid panel and liver profile in 6 weeks.

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