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2010 Survey. The National Lipid Association. Non-profit organization Directed toward advocacy for the education of health care professionals involved in the diagnosis and treatment of lipoprotein disorders and related metabolic diseases - PowerPoint PPT Presentation
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2010 Survey
The National Lipid Association
• Non-profit organization
• Directed toward advocacy for the education of health care professionals involved in the diagnosis and treatment of lipoprotein disorders and related metabolic diseases
• Developed in 1997 as outgrowth of Southeast Lipid Association by a group of lipid researchers and clinicians from southeastern U.S.
• 5 regional chapters
• Approximately 2500 active members in 2010
LIPID PULSE Objectives
• To better understand the practice dynamics, beliefs and behaviors of HCPs who specialize in lipid management
• To delineate the differences between respondents according to their practice’s degree of focus on lipid management
• To understand the awareness and utilization of various lipid parameters & information sources
• To understand the value NLA members place on NLA offerings
3
1. Lipid Pulse Membership Survey:
• Survey Design• Survey Market Promotion• Methodology• Respondent Groupings
4
Survey Design
• On-line, ~30-Question survey that took ~13 minutes to complete
• Developed, programmed, tested and launched by a team including representatives from Genzyme, NLA staff, NLA Board Leadership and Reckner/Blueberry
Clinician InformationClinician Information
Practice InformationPractice Information
Lipid ManagementPatient Information
Lipid ManagementPatient Information
Information ServicesInformation Services
NLA MembershipNLA Membership
Survey Promotional Efforts• Target List: 2,581 NLA members (2,490 w/ email)
• Honorarium / Incentive language: • The NLA is conducting a membership survey to get to know you and your practice better. When you complete the survey, you'll receive a $25 voucher to use on NLA products, a report of the survey results, and 25 copies of the Genzyme-published patient education booklet on Familial
Hypercholesterolemia. Help us achieve 100% participation!”
• Recruited: through email, fax, mail from May 11th to June 2nd; survey closed June 14th
• Key Activities:
– May 11th: An initial email & mail invitation was sent to all members with a valid email or mailing address• Timed to coincide with the NLA Scientific Sessions in Chicago, May 13-16 2010 where kiosk was present (attendees could take survey via kiosk or smartphone)
– May 20th: Follow-up email, fax, and USPS mailed invitation was sent to members who did not respond to the initial email or USPS invite. • Also, a reminder invitation was sent (via email or fax) to those members who started the survey but did not complete the survey
– June 2nd: A second follow-up email and fax invitation was sent to members who had not yet participated. • Also, a reminder invitation was sent (via email or fax) to those members who started the survey but did not complete the survey
6
Daily Responses vs. Promotional Activity
7
A star indicates a promotional activity occurred on this date (e.g., email/fax communication, USPS mailing)
# of
Res
pond
ents
# of
Res
pond
ents
Methodology
– 657 valid survey responses– 17 respondents were removed due to industry employment
– Pairwise comparisons between groups were tested at the 95% and 80% confidence interval throughout report– Charts, graphs and tables indicate comparisons that were significant at the 95% confidence level, using uppercase letters to denote columns against which comparisons were significant– Comparisons significant at the 80% confidence interval are denoted using lowercase letters– Note small base sizes of < n=30; interpret with caution
8
Respondent Groupings
– Respondents grouped according to self-reported:
– Profession (e.g., Physicians, NPs/PAs, Pharmacists or other)– Specialty* (e.g., IM/GP, Cardiologists, Endocrinologists or other)– Lipid Practice Profile
• Which best describes the role lipid management (plays) in your practice? My practice is a…a) Lipid Clinic (i.e. staff and time specifically dedicated to seeing patients for lipid disorders)
b) Lipid Specialist Practice (i.e. not a Lipid Clinic, but receive patient referrals from other clinicians for patients specifically for lipid management)
c) [neither] Lipid management is incorporated into my clinical practice,but I do not work at a Lipid Clinic, nor do I receive referrals specifically for lipid problems (i.e. neither a nor b)
9
* Only applies to MDs & NPs/PAs* Only applies to MDs & NPs/PAs
2. Respondent & Practice Profile• Geographic Distribution• Profession, Specialty & Lipid Practice Profile• Years in Practice • Practice Setting• Lipid Certification Status
10
Geographic Distribution - All Respondents*
* n=630 (27 respondents excluded because of undetermined addresses or international)* n=630 (27 respondents excluded because of undetermined addresses or international)
Geographic Distribution – By Lipid Practice Profile*
Lipid Clinic Lipid Clinic Other NLA RespondentOther NLA RespondentLipid Specialist Lipid Specialist
* n=628 (29 respondents excluded because of undetermined addresses or international respondents)* n=628 (29 respondents excluded because of undetermined addresses or international respondents)
Lipid Clinic Respondents Only*
* n=137* n=137
Geographic Distribution: Summary
• Lipid specialists tend to be clustered in urban areas
• Highest density of lipid clinics is seen in regions where initial NLA chapters were started: southwest, midwest and northeast
67%
8% 10%16%
0%
20%
40%
60%
80%
100%
PHYS NP/PA PHARM Other
Respondents by Profession
• Of the 657 respondents who completed the survey, 67% are physicians, 16% are NPs/PAs and 8% are pharmacists
– “Other” includes PhD/scientists, Nurses (4%), Registered Dieticians/nutritionists (RD) (4%), Ph.D. or science specialists (2%) and Certified Diabetes Educator (CDE) (<1%).
15
Base: All Respondents (n=657)Q1 Please indicate your profession (select one): (Are you a) Physician (MD/DO) Nurse Practitioner (NP), Physician’s Assistant (PA) , Dietician (RD), Exercise specialist,
Pharmacist, Ph.D. or science specialty, Certified Diabetes Educator (CDE) or Other: (Please specify)?
(n=439) (n=102) (n=53) (n=63)
% o
f R
es
po
nd
en
ts
ProfessionProfession
50%
11%7%
32%
0%
20%
40%
60%
80%
100%
IM/FP CARD ENDO Other
Respondents by Specialty
• About half of physician respondents are self-report as IMs or FPs
• Nearly a third of the respondents are cardiologists (CARDS)
16
Base: Physicians (n=436)Q3b Please describe your board certification: Cardiology, Endocrinology, Internal Medicine, Family Medicine, Other [specify]. Other includes Pediatrics, Lipidology/Clinical
Lipidology, Medical Biochem, and Nephrology.
(n=218) (n=138) (n=50) (n=30)
Board CertificationBoard Certification
% o
f P
hy
sic
ian
s
24%
43%
33%
0%
20%
40%
60%
80%
100%
Lipid Clinic Lipid Specialist Not Lipid Specialist
Respondents by Lipid Practice Profile
• About 57% of the respondents either work in a lipid clinic or receive referrals specifically for lipid management
17
Base: All Respondents (n=657)Q9 Which best describes the role lipid management (plays) in your practice [radio button]: (My practice is a) Lipid Clinic (i.e. staff and time specifically
dedicated to seeing patients for lipid disorders), lipid specialist practice (i.e. not a Lipid Clinic, but receive patient referrals from other clinicians for patients specifically for lipid management), Lipid management is incorporated into my clinical practice, but I do not work at a Lipid Clinic, nor do I receive referrals specifically for lipid problems (i.e. neither a nor b)
(n=155) (n=220) (n=282)
Lipid Practice ProfileLipid Practice Profile
% o
f R
es
po
nd
en
ts
57%57%
39%
69%
11%
7% 4%
34%
44%
19%
36%
15%
8%13%
0%
20%
40%
60%
80%
100%
Lipid Clinic Lipid Specialist Not Specialist
Other
ENDO
CARD
IM/FP
Lipid Practice Profile by Specialty
18
Base: Physicians (n=436). Q9 Which best describes the role lipid management (plays) in your practice [radio button]: (My practice is a) Lipid Clinic (i.e. staff and time specifically dedicated to seeing
patients for lipid disorders), lipid specialist practice (i.e. not a Lipid Clinic, but receive patient referrals from other clinicians for patients specifically for lipid management), Lipid management is incorporated into my clinical practice, but I do not work at a Lipid Clinic, nor do I receive referrals specifically for lipid problems (i.e. neither a nor b)
% o
f P
hy
sic
ian
s
(n=89) (n=163) (n=184)AA BB CC
Lipid Practice Profile by SpecialtyLipid Practice Profile by Specialty
ABAB
CCCC
• Physician respondent, most lipid clinics/specialists are either IM/FPs or CARDs
Years in Practice by Profession
• Respondent physicians appear to be significantly older than respondent NPs/PAs or pharmacists
– 41% of the respondent physicians had more than 26 years in practice– Cardiologists skew older than other specialties
19
7% 13% 15%10%
28% 23%25%
41%40%
17%
8%6%41%
10% 17%
0%
20%
40%
60%
80%
100%
PHYS NP/PA PHARM
26+
21-25 years
10-20 years
5-9 years
0-4 years22.4
12.6 14.6
0
20
40
60
80
100
PHYS NP/PA PHARM
Base: Physician/NP/PA/Pharm (n=594)Q2 How long you have been in clinical practice? [open # box] years [RANGE: 0-60]
Av
era
ge
# o
f Y
ea
rs
(n=102)(n=439) (n=53)
% o
f R
es
po
nd
en
ts
(n=102)(n=439) (n=53)
Average Years in Practiceby Profession
Average Years in Practiceby Profession
Years in Practice DistributionYears in Practice Distribution
AA BB CC AA BB CC
BCBC
bb
BCBC
BCBC
aa
AA
AA
AA
AA
AA
bb
Why Do Older Physicians Choose to Practice Clinical Lipidology?
• Less invasive
• More cognitive
• Desire to treat pathophysiology rather than symptoms of atherosclerosis
• Appreciation that it is the right thing to do
• Remembering that financial remuneration was not the reason we entered medicine
41%
29%
1% 1%
27%
0%
20%
40%
60%
80%
100%
PassedCertification
Preparing for Certification
Aware of/NotPursuing
Not Aware Not Asked
Lipid Certification Status
• Overall awareness of the lipid certification program is high
– Two-thirds of respondents have either passed or are preparing for certification
– One-third of respondents are aware of but not pursuing an NLA certification
21
Base: Physician/NP/PA (n=541). Physicians/NPs/PAs who self-identified as “Other” in Q1 were not asked Q4. Q4 How would you characterize your status in terms of Certification for Clinical Lipidology (MD) or Clinical lipid specialist (PA/NP)? [select one] (I am/have) Passed the
Certification Program, Preparing to pass the Certification Program, Aware of, but not pursuing the Certification Program , or Not aware of the Certification Program
(n=224) (n=147) (n=159) (n=5)
% o
f R
es
po
nd
en
ts
Lipid Certification Status Lipid Certification Status
(n=6)
Passed / Preparing 68%
Passed / Preparing 68%
Certification Status by Lipid Practice Profile
• Not surprisingly, Lipid Clinic or Lipid Specialist HCPs are more likely to be certified or plan to be certified
• About 40% of respondents who are non-lipid specialists/clinics are currently preparing to be certified
22
Base: Physician/NP/PA (n=541). Physicians/NPs/PAs that self-identified as “other” in Q1 were not asked Q4.Q4 How would you characterize your status in terms of Certification for Clinical Lipidology (MD) or Clinical lipid specialist (PA/NP)? [select one] (I am/have) Passed the
Certification Program, Preparing to pass the Certification Program, Aware of, but not pursuing the Certification Program , or Not aware of the Certification Program
28% 37%
17%17%
40%
52%60%
21%
2% 1% 1%1%1%2%21%
0%
20%
40%
60%
80%
100%
Lipid Clinic Lipid Spec Not Lipid Spec
Passed Certification
Preparing forCertification
Aware of/NotPursuing Certification
Not Aware
Not Asked
(n=114) (n=191) (n=236)
% o
f P
hy
s/N
P/P
A
Certification Status by Lipid Practice ProfileCertification Status by Lipid Practice Profile
AA BB CC
CCaCaC
ABAB
aBaBbb
Board Certification: Limitation of Lipid Pulse Survey
• 41% of respondents stated that they are board certified by the ABCL or ACCL
• As of November 2010, 691 or the active 2,461 active members (28%) were board certified
• Thus, respondents likely represent a more engaged group than the general membership
22%
36%42%
0%
20%
40%
60%
80%
100%
Solo Group - Single Specialty Group - Multi-Specialty
Type of Practice
• Nearly four-fifths of Physicians/NP/PA/Pharms work in either a single-specialty or a multi-specialty group practice; the remainder are in solo practice.
24
(n=129) (n=249) (n=216)
% o
f R
es
po
nd
en
ts
Practice TypePractice Type
AA BB CC
Base: Physician/NP/PA/Pharm (n=594)Q5 Please describe your clinical practice (select one): Is it a Solo, a Group – Single Specialty, or a Group – Multi-Specialty practice?
Group - 78%Group - 78%
Base: Physician/NP/PA/Pharm (n=594). Respondent may report more than on practice setting.Q6 Which best describes your practice setting (select all that apply): a) Private practice
(office-based), Academic/research, Hospital-based , Pharmacy-based, Community clinic or Other setting ? [free text]
60%
28%
2%7%
0% 1%
25%
0%
20%
40%
60%
80%
100%
Office-Based(Private)
Academic Hospital-based Pharmacy-based
Clinic* Residency Other misc.
Practice Setting
• A majority (60%) of respondents are office-based
• More than one-fourth work in a hospital (outpatient clinics included)
• “Academic” indicates both hospital and clinic affiliation with an academic institution
25
% o
f R
es
po
nd
en
ts
Practice Setting(check all that apply)Practice Setting
(check all that apply)
*Includes Community, HMO and Other
3. Staffing & Patient Volume• FTEs• Total Patient Volume • Hours Per Week Seeing Patients
26
11.7 12.0
9.2
0
5
10
15
20
Lipid Clinic Lipid Spec Not Lipid Spec
28%23%
11%
31%33%
15%8%
32%36%
6%
27%
7%12%
15%16%
0%
20%
40%
60%
80%
100%
0-2.0 2.1-4.0 4.1-6.0 6.1-8.0 8.1 ore more
Lipid Clinic
Lipid Spec
Not Lipid Spec
(n=205)
(n=134)
(n=255)
AA
BB
CC
Total Clinician Staffing in Practice (FTEs)
• Reflecting presence in group practices, Lipid Clinics and Lipid Specialists describe working with more staff
27
% o
f R
es
po
nd
en
ts
Average # of FTEsAverage # of FTEs Staffing in FTEs DistributionStaffing in FTEs Distribution
(n=205)(n=134) (n=255)AA BB CC
Base: Physician/NP/PA/Pharm (n=594)Q12 In terms of full-time equivalents (FTEs), including yourself, how many clinicians are in your practice?
Av
era
ge
# o
f F
TE
s
cc cc
aa AA
BCBC
# of FTEs
Total Patient Volume
• Respondent clinicians who work in lipid clinics see a lower overall volume of patients
– Possible reasons include academic research, clinical trial activities and other responsibilities
28
Base: Physician/NP/PA/Pharm (n=594)Q8 How many patients are under your care in your personal practice? If NA enter zero. [# box – 5 digits (0-99999)]
13% 11%
20%
5% 2%7%
29%
14% 15%
28%34%
26%25%
39%33%
0%
20%
40%
60%
80%
100%
Lipid Clinic Lipid Spec Not Lipid Spec
0 1-99 100-499 500-1,999 2,000+
1,082
1,6921,430
0
1000
2000
3000
Lipid Clinic Lipid Spec Not Lipid Spec
Av
era
ge
# o
f P
ati
en
ts
(n=205)(n=134) (n=255)
% o
f R
es
po
nd
en
ts
(n=205)(n=134) (n=255)
Average # of PatientsAverage # of Patients Patient DistributionPatient Distribution
AA BB CC AA BB CC
AcAc
bb
aa
BCBCCC
AcAc
aBaB
BB
aa
Hours Per Week Seeing Patients
• Respondent clinicians who work more in lipid-focused settings spend less of their time actually seeing patients for all types of medical issues
29
Base: Physician/NP/PA/Pharm (n=594)Q10 Please indicate the number of hours per week you spend seeing patients. If NA enter zero: [# - 2 digits (0-99)]
1% 2% 4%
37%
12% 13%
38% 37%
28%25%
49%55%
0%
20%
40%
60%
80%
100%
Lipid Clinic Lipid Spec Not Lipid Spec
0 1-19 20-39 40+
25.134.7 35.3
0
20
40
60
80
100
Lipid Clinic Lipid Spec Not Lipid Spec
Av
era
ge
Ho
urs
Pe
r W
ee
k
(n=205)(n=134) (n=255)
% o
f R
es
po
nd
en
ts
(n=205)(n=134) (n=255)
Average Hours Per Week Seeing Patients
Average Hours Per Week Seeing Patients
Hours Per Week Distribution
Hours Per Week Distribution
AA BB CC AA BB CC
BCBC CC CC
AA
abab
AA
AA AA
4. Lipid Practice Characteristics• Practice Services• Lipid Management Staffing• Lipid Management Patient Volume• Time Respondents Spend Seeing Lipid Management Patients• Anticipated Changes in Lipid Practice Characteristics• Loss / Profitability
30
Frequency of Practice Services
• More than half of practices provide diabetes management, nutrition/exercise programs, and weight management services.
31
69%59%
41%
24%
10% 6% 6% 5% 1%
60%
0%
20%
40%
60%
80%
100%
Diabetesmanagement
Nutrition/Exerciseprograms
WeightManagement
Clinical trialparticipation
CardiacRehab
LDLApheresis
Other HTN/Lipids
Diagnosis &Mgt.*
Other Misc./GeneralHealth**
Other CardioServices***
OtherTeaching,
EducationalServices****
% o
f R
es
po
nd
en
ts
Base: Physician/NP/PA/Pharm (n=594). Total is greater than 100% due to multiple responses.Q15 Please indicate which of the following services your practice provides: [check boxes], Clinical trial participation, Cardiac rehab, Diabetes management, Nutrition/exercise
programs, Weight management, LDL apheresis, Other – please specify [fill in blank]
*Includes: Lipid management, Hypertension/Anticoagulation Management, CIMT, HTN management, Advanced lipid/lipoprotein testing**Other miscellaneous mentions, Internal medicine, Lab, Sports medicine***Non-Invasive Cardiology Diagnostics, General (e.g. Stress testing/(nuclear/echo), Cardiology services (general cardiology/non specific), Preventive
Cardiology Services & Risk Assessment ((non-specific)), Interventional Cardiology****Smoking cessation, Diabetes education, Teaching/education (non-specific), Med management/education (non-specific)
60%
71%63%
34%
19%
7%1%
6%2%
71%
12%5% 4% 4% 1%
73%
52%
15%
4% 6% 9% 6%2%
79%
60%62%
30%
46%48%
26%
0%
20%
40%
60%
80%
100%
Diabetesmanagement
Nutrition/Exerciseprograms
WeightManagement
Clinical trialparticipation
CardiacRehab
LDLApheresis
Other HTN/Lipids
Diagnosis &Mgt.*
Other Misc./GeneralHealth**
Other CardioServices***
OtherTeaching,
EducationalServices****
Lipid Clinic Lipid Spec Not Lipid Spec
Services Provided by Lipid Practice ProfileServices Provided by Lipid Practice Profile
Frequency of Practice Services
• Lipid Clinics (to a lesser extent Lipid Specialists) are more likely to offer nutrition/exercise programs, weight management and clinical trial participation
32
Base: Physician/NP/PA/Pharm (n=594). Total is greater than 100% due to multiple responses.Q15 Please indicate which of the following services your practice provides: [check boxes], Clinical trial participation, Cardiac rehab, Diabetes management, Nutrition/exercise
programs, Weight management, LDL apheresis, Other – please specify [fill in blank]
% o
f R
es
po
nd
en
ts
(n=134) (n=205) (n=255)AA BB CC
AA AABCBC
BCBC
BCBC
CC
CCcc
CC
CC
bCbC
CC
aaAbAb
bb
Frequency of Practice Services Offered:Study Limitation
• Note that 10% of respondents reported that LDL apheresis is offered in their practice
• This response is clearly not reflective of the general membership of clinical lipidologists
2% 1% 2% 1%
60% 60%
80%71%
30% 33%
11% 24%
6% 7% 5%9%
0%
20%
40%
60%
80%
100%
Lipid Clinic Lipid Spec Lipid Clinic Lipid Spec
Base: Physician/NP/PA who works in a Lipid Clinic or Lipid Specialist practice (Q9) (n=305)Q20 Please describe the changes in your lipid management practice (in terms of Decrease(d) No(t) Change(d) Increase(d))Over the past year my patient volume has… // Over the next 3 yrs, I expect patient volume to… // Over the next 3 years, I expect staffing needs to… // Over the next 3 years, I expect equipment needs to… // Over the next 3 years, I expect payer (insurance/Medicare/Medicaid) reimbursement pressures to…
Past Year and Anticipated Changes: Patient Volume• About 60% of LC/LSs respondents indicate that their patient volume has
increased in the past year
• Lipid clinic respondents are slightly more likely than lipid specialists to expect increased patient volume in the next 3 years
34
% o
f P
hy
sic
ian
s
Over the past year my patient volume has… Over the past year my patient volume has… Over the next 3 years, I expect patient volume to… Over the next 3 years, I expect patient volume to…
AA
bb
Not askedIncreaseNo ChangeDecrease
(n=114) (n=191)AA BB
(n=114) (n=191)AA BB
Loss/profitability
• Respondents who work in lipid clinics (only) were asked about the profitability of their practices
– Approximately two-thirds of these respondents say they operate at break-even or better
35
Base: Physician/NP/PA/Pharm (for Profession and Lipid Practice Profile) who works in a Lipid Clinic (Q9) (n=134)Base: Physician (Speciality) who works in a Lipid Clinic (Q9) (n=89) Q21 From a financial standpoint, do you consider your lipid clinic to be operating (select one): [radio button] At break-even or better , At a loss.
34% 36% 33%25% 31% 28%
60%
42%
64% 67%75% 69% 72%
40%
58%66%
0%
20%
40%
60%
80%
100%
Lipid Clinic PHYS NP/PA PHARM FM/IM CARD ENDO Other
by Professionby Profession
(n=134) (n=90) (n=24)* (n=20)* (n=35) (n=32) (n=10)* (n=12)*
At a lossAt break-even or better
by Specialtyby Specialty
% o
f P
hy
sic
ian
s
AA BB CC AA BB CC DD
cccc
abab
by Lipid Practice Profile
by Lipid Practice Profile
*Note: Small base size. Interpret with caution*Note: Small base size. Interpret with caution
Loss/Profitability:Limitations of Lipid Pulse Survey
• Survey only employed financial appraisal by clinician
• No verification by administrator of CFO
• Likely result is an overestimation of profitability of many of these programs
• Are endocrinologists really different?
5. Lipid Management Referral Patterns• Referral Patterns• Referral Reasons
37
11% 10% 4%
27%4% 3%4%
8%22%
16% 24%
15%
71% 68%50%
63%
0%
20%
40%
60%
80%
100%
IM/FP CARD ENDO Other
(n=269)Base: Respondent is a Physician, NP or PA at Q1, Lipid clinic/specialist at Q9 and has patients referred for lipid management specifically at Q17 Q18 Of referrals you receive for lipid management, please describe the type of referring clinicians: [enter the % of referred patients] GP/FP or Internist, Cardiologist,
Endocrinologist, Other, please specify______ , Other, please specify______ [sum to 100%]
Me
an
% R
efe
rre
d
Fro
m S
pe
cia
lis
t
Lipid Management Referral Patterns by SpecialtyLipid Management Referral Patterns by Specialty
OtherENDOCARDIM/FP
(n=85) (n=99)AA BB
Lipid Management Referral Patterns
• Amongst LC/LSs referral sources are fairly similar across all specialty types
• Respondent IM/FPs do receive about 20% of their referrals from cardiologists
38
(n=34)CC
(n=17)*DD
dd
BB
aDaD DD
bDbD
aBaB
*Note: Small base size. Interpret with caution*Note: Small base size. Interpret with caution
Elevated LDL-C
Hypertri-glyceridemia
Isolated low HDL
Combined dyslipidemia
Statin-intolerance
Presence of CVD or evidence of risk with normal lipid profile
Other
Lipid Management Referral Reasons
• Respondent Lipid Clinics/Specialists receive patient referrals for similar reasons– About half are due to elevated LDL-C, combined dyslipedmia – Statin intolerance accounts for ~ 20%– High TGs makes up just under 20% of referrals
7% 6%
20% 19%
25% 24%
7% 8%
18% 17%
24%
1%1%
22%
0%
20%
40%
60%
80%
100%
Lipid Clinic Lipid Spec
Me
an
% R
efe
rre
d
Fro
m S
pe
cia
lis
t
Reasons for Lipid Management Referral by Lipid Practice ProfileReasons for Lipid Management Referral by Lipid Practice Profile
(n=269)Base: Respondent is a Physician, NP or PA at Q1, Lipid clinic/specialist at Q9 and has patients referred for lipid management specifically at Q17 Q19 Of those patients referred to you for lipid management, please indicate the reason for referral: Enter the % Patients seen for Elevated LDL-C, Hypertriglyceridemia, Isolated
low HDL, Combined dyslipidemia, Statin-intolerance, Presence of CVD or evidence of risk with normal lipid profile, Other, please specify______ , Other, please specify______ [sum to 100%]
(n=97) (n=172)AA BB
6. Beliefs & Information Sources• Tests Routinely Ordered• Parameters Most Predictive of Cardiovascular Risk• Education Needs• Information Mediums / Sources • New Product Awareness
40
Tests Routinely Ordered
41
Lipid Clinici Lipid Specj Not Lipid Speck
(n=114) (n=191) (n=236)
Triglycerides 93% 95% 95%
HDL-C 95% 95% 96%
LDL-C 91% 93% 92%
Non-HDL 68% 78% I 77% I
CRP 63% 62% 66%
Lp(a) 62% jK 54% K 42%
Apo B 52% k 51% k 42%
Lipoprotein particle size 41% 44% 42%
Lipoprotein particle # 38% 61% IK 42%
APO E 19% k 17% k 12%
Lp-PLA2 18% 30% Ik 23%
Other apolipoproteins 14% K 10% k 6%
Genetic testing for FH 9% jK 4% 3%
Genetic markers, e.g., KIF6 7% 16% Ik 10%
None of the above 1% 1% 1%
Not asked 2% 1% 1%
Base: All Respondents (n=657)Q22-1. Of the lipid parameters and related topics listed below: What tests do you order routinely (more than once a month in your overall practice)? (check all that apply)
Global risk scores (such as the Framingham Risk Score [FRS]) that use multiple traditional cardiovascular risk factors should be obtained for risk assessment in all asymptomatic adults without a clinical history of CHD. These scores are useful for combining individual risk factor measurements into a single quantitative estimate of risk that can be used to target preventive interventions.
I IIa IIb III
Recommendations for General Approaches to Risk Stratification
Benefit>>>RiskShould be performedLimited populations
2010 ACCF/AHA Guideline for Assessment of Cardiovascular Risk in Asymptomatic Adults
>90% order lipid profileLipid profile enables global risk scoring>90% order lipid profileLipid profile enables global risk scoring
Recommendations for Measurement of C-Reactive Protein (CRP)
In men 50 years of age or older or women 60 years of age or older with LDL cholesterol less than 130 mg/dL; not on lipid-lowering, hormone replacement, or immunosuppressant therapy; without clinical CHD, diabetes, chronic kidney disease, severe inflammatory conditions, or contraindications to statins, measurement of CRP can be useful in the selection of patients for statin therapy.
I IIa IIb III
2010 ACCF/AHA Guideline for Assessment of Cardiovascular Risk in Asymptomatic Adults
Benefit>>RiskIs reasonableLimited populations
>60% order hs-CRP>60% order hs-CRP
Lipoprotein-associated phospholipase A2 (Lp-PLA2) might be reasonable for cardiovascular risk assessment in intermediate-risk asymptomatic adults.
Recommendation for Lipoprotein-associated Phospholipase A2
I IIa IIb III
2010 ACCF/AHA Guideline for Assessment of Cardiovascular Risk in Asymptomatic Adults
Benefit ≥ riskMay/might be consideredLimited populations
18-30% order Lp-PLA218-30% order Lp-PLA2
Measurement of lipid parameters, including lipoproteins, apolipoproteins, particle size, and density, beyond a standard fasting lipid profile is not recommended for cardiovascular risk assessment in asymptomatic adults.
Recommendation for Lipoprotein and Apolipoprotein Assessments
I IIa IIb III
Not recommended
2010 ACCF/AHA Guideline for Assessment of Cardiovascular Risk in Asymptomatic Adults
56-61% order apo B 38-61% order LDL-P
18-28% order particle size29-35% order Lp(a)
56-61% order apo B 38-61% order LDL-P
18-28% order particle size29-35% order Lp(a)
Parameters Most Predictive of CV Risk
46
Base: All Respondents (n=657)Q22-2. Of those listed, which 5 parameters you believe to be most predictive for assessing CV risk? (select 5)
Lipid Clinici Lipid Specj Not Lipid Speck
(n=114) (n=191) (n=236)
HDL-C 63% j 55% 58%
CRP 47% K 41% 36%
Non-HDL 61% 59% 57%
Apo B 61% 60% 56%
LDL-C 55% 48% 56% j
Lipoprotein particle # 50% 56% k 50%
Lp(a) 35% 32% 29%
Lipoprotein particle size 23% 18% 28% J
Triglycerides 19% 25% 29% I
Lp-PLA2 16% 22% I 18%
Genetic markers, e.g., KIF6 7% 6% 6%
Genetic testing for FH 4% 2% 5% j
APO E 3% 6% ik 3%
Other apolipoproteins 3% 3% 2%
None of the above 1% j 0% 1% j
Greatest Need for Education/Awareness
47
Base: All Respondents (n=657)Q22-3. Of those listed, the 5 topics where you believe there is greatest need for increased awareness and/or education? (select 5)
Lipid Clinici Lipid Specj Not Lipid Speck
(n=155) (n=200) (n=282)
Statin intolerance: evaluation and management 57% JK 39% 36%Strategies for improving patient compliance with therapy
(medication and/or diet/lifestyle) 52% Jk 37% 43% j
Metabolic syndrome 45% jk 37% 35%Genetic testing for FH 21% j 13% 18% j
Lipoprotein particle # 34% 41% ik 33%Non-HDL 30% 26% 26%
Apo B 30% 36% ik 30%Genetic markers, e.g., KIF6 27% 30% 25%
Lp-PLA2 24% 33% I 31% I
Familial hypercholesterolemeia screening and diagnosis 23% 18% 22%Lipoprotein particle size 19% 16% 23% J
Lipid clinic practice management 17% 15% 24% iJ
Lp(a) 15% 21% I 21% I
HDL-C 14% 19% I 17%CRP 12% 16% 14%
Triglycerides 11% 18% ik 12%Other apolipoproteins 8% 8% 9%
APO E 6% 10% I 13% I
LDL-C 3% 6% 10% Ij
None of the above 1% 1% 1%
Sources Used to Learn About Lipid Management
48
88%
62%
45%
27%
5% 1%
88%
0%
20%
40%
60%
80%
100%
Reading journals(printed versions)
Attendingconferences
Reading journalwebsites or email
updates
Reading other on-line sources (not
journals)
Listening to orwatching Pod-castsor other audio/video
lectures on-line
Reading orparticipating in on-
line chat roomswith peer clinicians
None of the above
% o
f R
es
po
nd
en
ts
Base: All respondents (n=657). Total is greater than 100% due to multiple responses. Top mentions noted in text boxes.Q23. Which sources do you use to learn about lipid management? Which ones?
Journal of Clinical Lipidology/Journal of Lipidology 45%
NEJM 23%Lipid Spin 20%JACC 20%Circulation 16%JAMA 10%
NLA
63%AHA
21%ACC
19%
NLA
23%NEJM
13%Heart.org
12%Medscape
12%
Heart.org
17%Medscape
13%NLA
12%UpToDate
11%
NLA
27%ReachMD
12%Heart.org
10%NLA
42%Heart.org
9%
• Respondents cite JCL, NEJM and JACC as most often used sources for LM information
• ~60% describe reading journals online; 45% use other (non-journal) online source
Awareness of Technologies/Therapies in Development
49
Base: All Respondents (n=657)Q26. What - if any - new therapies or technologies in development for lipid management are you aware of? Open-end - Top mentions shown.
% of Total
CETP inhibitors/blockers 11.1% (n=73)Genetic testing/screening 4.7% (n=31)
LDL Apheresis/apheresis/DALI LDL apheresis 4.6% (n=30)Mipomersen 4.3% (n=28)
New drugs (to replace statins)/new statins 2.7% (n=18)LpPLA2 2.7% (n=18)
HDL therapy/drugs/formulations/in development (unspecified) 2.4% (n=16)apoB antisense/inhibitors 2.3% (n=15)
Meds/therapy to raise HDL 1.8% (n=12)apo A1 infusion/mimetics infusion 1.8% (n=12)
KIF6 1.8% (n=12)HDL Mimetics 1.5% (n=10)
Antisense oligonucleotides/antisense therapy 1.5% (n=10)MTP inhibitors 1.5% (n=10)
Particle #/HDL particle #/lipoprotein particle #/lipid particle # 1.4% (n=9)Gene therapy 1.2% (n=8)
RNA1/antisense RNA 1.2% (n=8)Low flush/no flush niacin/niacin combo 1.2% (n=8)
CIMT 1.1% (n=7)HDL infusion therapy 1.1% (n=7)
Summary of Tests Ordered and Information Sources/ Needs
• Lipid Tests Routinely Ordered– Over 90% routinely order the standard lipid panel (e.g., HDL, LDL, TG)– About half of the MD respondents reported regularly (>once/month) ordering particle #, Lp(a), Apo B (Two-thirds said CRP) in addition to the standard lipid panel– Lp(a) and Apo B were found to be more common in more lipid-centric physicians
• Lipid Parameters Most Predictive of CV Risk– Non-HDL/Apo B believed to be the same in terms of being most predictive of risk
• However, Apo B is ordered less often, this is likely because clinicians can obtain non-HDL for free of cost w/ standard panel
– Followed by HDL, then lipoprotein particle #• Interestingly, lipid clinic physicians frequently indicated that genetic testing for FH was one of the top five parameters to measure CV Risk
• Greatest Need for Education/Awareness– Statin intolerance / patient compliance were frequently mentioned
• These are related and appear more frequently in lipid clinic responses compared to other clinicians
– Lipoprotein particle # is also a top interest
51
7. NLA Membership• Membership Benefits• Membership Continuation• Promotion to Colleagues• NLA Suggestions
NLA Membership Summary
• Respondents indicate that education, certification & The Journal of Clinical Lipidology subscription are most valued
• Over 95% of respondents intend to continue their NLA Membership & would promote it to colleagues
• About half of survey respondents offer suggestions for additional services– A majority of these respondents suggest enhancing educational programs, conferences, and using a web-based medium to increase participation
NLA Membership Benefits
• Respondent physicians and NP/PAs utilize the Journal of Clinical Lipidology subscription more than pharmacists.
• Respondent NP/PAs and pharmacists value the certification opportunities more than physicians and others.
• Respondent pharmacists value social networking/access to thought leads more than physicians and NP/PAs
53
Base: All Respondents (n=657)Q27 What benefits of NLA membership do you value most? (select up to three) Responses accounting for less than 1% (Lipid Spin, other, and none) are not shown.
15%
89%
43%
20%
68%
7%7%
16%
93%
71%
18%11%
23%
87%
32%
59%
11%5%
25%
89%
41%
25%
67%
14%
29%
54%
18%
59%
0%
20%
40%
60%
80%
100%
Advocacy Colleagues Educationopportunities
Certificationopportunities
Social Networking /Access to Thought
Leaders
Journal of ClinicalLipidology
subscription
Member discountfor educationalopportunities
PHYS NP/PA PHARM Other
% o
f R
es
po
nd
en
ts
(n=439) (n=102) (n=53)AA BB CC
BDBD
by Professionby Profession DD(n=63)
dd
BBbb
cc
AdAd AdAd
ABAB
cc cc
AAAA
98% 94% 97%97%
0%
20%
40%
60%
80%
100%
PHYS NP/PA PHARM Other
NLA Membership Continuation
• The vast majority of respondents plan to continue their membership.
• A very small minority plan to not renew for cost/expense or other reasons (open-ends).
54
Base: All Respondents (n=657)Q28 Do you plan to continue your membership in the NLA? (Yes/No)
by Professionby Profession
% o
f R
es
po
nd
en
ts
(n=439) (n=102) (n=53) (n=63)AA BB CC DD
CC
NLA Promotion to Colleagues
• Virtually all respondents would encourage their colleagues to join the NLA.
– The few exceptions cite reasons including colleagues’ lack of expressed interest
55
Base: All Respondents (n=657)Q29 Would you encourage colleagues to join the NLA? (Yes/No)
98% 98% 94%98%
0%
20%
40%
60%
80%
100%
PHYS NP/PA PHARM Other
by Professionby Profession
% o
f R
es
po
nd
en
ts
(n=439) (n=102) (n=53) (n=63)AA BB CC DD
dd dd
Suggested NLA services
• Only about half of survey respondents offer suggestions for additional services
• A majority of these respondents suggest enhancing educational programs, conferences, and using a web-based medium to enhance participation in the organization
• The top suggestions for NLA are providing more services around education/learning and conferences/meetings
56
Base: All Respondents (n=657)Q30 What else could the NLA provide its members that it does not currently provide? (open-end) Nets are shown.
PHYSA NP/PAB PHARMC OtherD
(n=439) (n=102) (n=53) (n=63)
Education/learning 17% 16% 15% 11%Conferences/meetings 10% c 8% 4% 6%
Web-based 7% 9% 13% a 10%Conference content 6% c 7% c 0% 11% aC
Miscellaneous 6% 3% 2% 6%Awareness 6% B 0% 2% b 8% Bc
Communication 3% 1% 8% aBd 2%Cost 2% 7% Ac 2% 5% a
Recognition as specialty 3% bc 0% 0% 2%Participation 1% 4% ad 4% ad 0%
Interaction 2% 2% 4% 2%Membership 1% 1% 2% 3% a
Nothing/doing great job/fine as is 33% 35% 45% a 41%Don't know 6% 13%AcD 6% 3%No answer 3% d 1% 2% 0%
Summary• Survey provided valuable, meaningful data to characterize clinicians that focus on lipid management (NLA members)
• In general, greater differences in respondents wereobserved by degree of lipid practice profile (e.g., lipid clinic vs. lipid management vs. neither) than by specialty
• Respondents that identify themselves as working in a lipid clinic or specialists are differentiated in terms of clinical environment and patient offerings
In terms of practice environment, these specialists: – Appear more likely to work in multi-specialty or group practices – Lipid clinic respondents in particular were more likely to have an academic affiliation
Summary
• Lipid Clinic (LC)/Lipid Specialist (LS) Practice Characteristics – LC/LSs report slightly lower patient volume overall and spend fewer hours/week with in partient care (potentially reflecting academic setting and related activities)
– LC/LSs tend to spend more time with their patients, especially on initial visits
– LC/LSs are more likely to offer comprehensive services beyond purely medical care to address cardiovascular risk with services such as weight management, nutrition/exercise counseling, clinical trial participation and cardiac rehabilitation services
– Respondents in these categories appear to expect an acceleration in expected demand for lipid management
Summary• Lipid Tests Routinely Ordered
– Over 90% routinely order the standard lipid panel (e.g., HDL, LDL, TG)– About half of the MD respondents reported regularly (>once/month) ordering particle #, Lp(a), Apo B in addition to the standard lipid panel; 2/3 said the same re; CRP– Lp(a) and Apo B tests appear more frequently ordered by lipid specialists and lipid clinic respondents than by those w/ out a more dedicated practice for lipid management
• Lipid Parameters Most Predictive of CV Risk– Non-HDL and Apo B are tied re: belief re: being the most predictive of risk
• However, Apo B is ordered less often, likely reflecting cost/availability– Followed by HDL, then lipoprotein particle #
• Interestingly, lipid clinic physicians frequently indicated that genetic testing for FH was one of the top five parameters to measure CV Risk
• Greatest Need for Education/Awareness– Statin intolerance / patient compliance were frequently mentioned
• These are related and appear more frequently in lipid clinic responses compared to other clinicians
– Lipoprotein particle # is also a top interest, as is Apo B