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| Abstract | The author manages a private clinic oriented towards holistic community-based primary health care (PHC) hosting a family doctor (FD) team, medical specialists and PHC professionals, all organised within multidisciplinary service-oriented teams. The three-member FD team uses the electronic medical record (EMR) Transhis, designed to capture data on patients symptoms, doctors interventions and diagnostic labels during patient-doctor encounters. The tool used for data aggregation and analysis is the International Classification of Primary Care, ICPC-2-E, and the author has published aggregated data from a FD practice network (Soler and Okkes, 2004). The authors practice population is rather young and hyperlipidaemia is a common diagnosis, representing 2.2% of all diagnoses and nearly 7 diagnoses per 100 patients seen over one year. The prevalence of hyperlipidaemia is about 13% in those over 25 years of age, higher than the rest of the registration network, possibly due to increased surveillance. More than 100 blood tests a year are performed in the practice, many of which involving screening for lipid problems. In fact, the 66 patients with hyperlipidaemia in the authors practice generated 211 encounters in 4 years, and involved 39 blood profiles (representing 9.2% of 422 blood profiles performed to all patients in the period) but only 5 referrals to secondary care. Most are young healthy patients (83% of hyperlipidaemic patients are aged between 25 and 64), and primary prevention is the main focus. Taking the lower value attached to one QALY (US$ 40,000), the optimal 5-year CHD risk threshold for treatment with statins would be 3.4% for 35-year old males (3.0% in women), 6.5% for 50-year old males (5.1% in women) and 17.3% for 65-year old males (15.8% in women). However, three principal cost estimate entered in the model seem to differ markedly from the Swedish figures: statin treatment in private Maltese PHC is cheaper, (costing around Lm 180 (US$ 500) annually, not including Lm 50 (US$138) for blood tests and doctor fees); a middle-class individual would earn around Lm 6,000 to Lm 10,000 annually (US$ 16,500 to US$ 27,500) whilst the lowest value for one QALY in the model was valued at US$ 40,000; and health care costs of morbidity seem to be lower than the figures used by Johannesson (2001). In the sensitivity and subgroup analysis, reducing the cost of interventions from US$ 894 to US$ 600 reduced the risk threshold from 4.6% to 3.9%, and reducing the CHD annual morbidity costs by 50% increased the risk threshold to 5.1% (in 50 year-old males with US$ 60,000 value per QALY). Thus the risk levels in Maltese patients may be expected to be higher than the Swedish model due to the former three effects. Additionally, the risk of harm from statins, estimated to cause 1% increase in 10-year mortality, seems not to have been incorporated in this decision analysis. |
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| Journal | Evidence Based Health Care Module, MSc. Primary Health Care, University of Ulster |
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| Key words | Primary health care, family practice, hyperlipidaemia, statins, management, prevalence, Transhis, electronic medical record |