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Such patients with complex conditions met the criteria for Chronic Disease Management plans, 14 which are listed on the Medicare Benefits Schedule (MBS items 721 and 723). Patients whose FH was assessed as low-to-intermediate complexity were managed by a GP/practice nurse (PN), with a shared-care approach with a lipid specialist available if required and for patients with complex conditions. A phenotypic diagnosis of FH was made for those with a Dutch Lipid Clinic Network Criteria (DLCNC) score 6 of ≥6. 13 Those patients were recalled for clinical assessment and medical history review by GPs. Medical records from 232,139 patients were screened using a validated data extraction tool, TARB-Ex, to identify patients at high risk. 11 Fifteen general practices from five Australian states participated in the study. The study protocol has been published previously, 12 as have results from screening and management phases. Second, we aim to model the cost effectiveness of GP identification and management of patients with FH, seeking to avert costly downstream management in the tertiary setting due to delayed diagnosis and management. First, we describe the management pathways and associated costs for patients with FH in the general practice setting.
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The present study examines the following. This provides an opportunity and imperative to estimate the cost effectiveness of such an approach. 11 Using a two-stage approach combining electronic medical record screening and subsequent clinical assessment, 147 patients with phenotypic FH were identified, with further evidence of lowered LDL-C levels from GP management. Our recent study indicated that detection and management of FH in general practice is feasible and scalable on a national level. 4,9,10 However, health economic evaluation of such an increased general practice role is still lacking. The potential economic benefits of such an approach are becoming more attractive, with increasing evidence for earlier, more comprehensive and finely tuned management approaches. 9 A shared model of care between non-GP specialists and GPs is recognised as offering the optimal approach for future management, especially for patients at low-to-intermediate risk. 5,7,8īecause of their central position in the healthcare system in Australia coupled with easy access to primary care services, general practitioners (GPs) are well placed to play a larger part in improving FH detection and management. Some of the largest gaps in FH detection exist among patients attending primary healthcare settings. 5 This is mainly due to a lack of effective screening strategies for potential index cases in the community 6 followed by appropriate management of the condition and subsequent cascade testing of close relatives. 4 Despite increased attempts to improve awareness, FH continues to remain underdiagnosed and undertreated. 1–3Įarly detection and treatment are clinically and economically effective, but detection rates worldwide remain low at approximately 1%. Familial hypercholesterolaemia (FH) is a co-dominantly inherited disorder of low-density lipoprotein cholesterol (LDL-C) metabolism characterised by elevated levels from birth that can progress to premature atherosclerotic coronary artery disease if left untreated.