Strategy 1

The flow diagrams show the strategies used, for primary and secondary coronary prevention, either not receiving (strategies 1 and 3) or receiving (strategies 2 and 4) lipid lowering therapy. These were entered into the laboratory information management system and ran automatically for each laboratory request, generating automatic comments and triggering the appropriate tests and interpretative comments.

The strategies may be tailored depending on individual laboratory instrumentation and facilities. In the case described, HDL (high density lipoprotein) measurement was relatively expensive, and an initial decision was taken to target a minimum of one HDL measurement in each patient prior to lipid lowering drug therapy. This was supplemented by triglyceride measurement if the total cholesterol was above the target level. The net result of adding HDL in those practices which rarely measured it and removing HDL from those who requested it systematically produced a fall in test activity and modest marginal savings to the laboratory of £7000 per annum.

Strategy 1