Table 2 Description based on Proctor’s guidelines for specifying implementation strategies: components of the multidisciplinary lipid clinic

Name it

Creation of new clinical teams (a multidisciplinary lipid clinic)

Define it

A multidisciplinary clinical team that has complementary roles (i.e., diagnosis and treatment) with lipid expertise that is formed to improve patient care

 Actors

Cardiologist

Pharmacist

Genetic counselor

 Actions

Cardiologist—evaluates the patient’s symptoms, lifestyle, medications, and past lab results during an initial in-person visit; recommends a treatment plan; orders subsequent testing; requests follow-up visits as needed

Pharmacist—evaluates the patient’s current medications; offers input/suggests changes to medications; performs medication reconciliation; completes medication counseling and education; ensures prior authorizations are submitted

Genetic counselor—evaluates the patient’s past medical and family histories; assesses the patient’s risk; provides pre-test genetic counseling; provides genetic testing result disclosure and post-test genetic counseling; discusses cascade testing of at-risk relatives

 Targets of the action

All clinicians—have expertise caring for patients with a high-risk lipid condition and knowledge of guideline-recommended treatment for lipid conditions

Cardiologist—diagnosis of lipid conditions, monitors clinical symptoms

Pharmacist—optimizes treatment and follow-up on prior authorizations

Genetic counselor—knowledge of familial cardiovascular conditions, improvement of identification methods for concerning past medical/family history, and reassurance to the patient that the testing results will benefit the patient no matter if the result is positive or negative

 Temporality

Patients should be referred as soon as the provider identifies a patient with a high-risk lipid condition who would benefit from the evaluation at the clinic. The initial visit to the clinic should take place as soon as scheduling allows after the patient has been referred. Subsequent visits should be scheduled on an as needed basis.

 Dose

Cardiologist—once at an hour-long initial visit. Subsequent visits at 6–8 weeks post-initial visit and further if needed. The cardiologist will be available to the patient via phone or through patient portal.

Pharmacist—once at an hour-long initial visit. The pharmacist will be available to the patient via phone or patient portal.

Genetic counselor—once at an hour-long initial visit. The genetic counselor will be available to the patient via phone or patient portal.

 Implementation outcomes affected

Uptake of guideline-recommended testing and treatment for high-risk lipid clinic patients; adoption of the clinic among PCPs and other providers; penetration among eligible patients; fidelity to the protocol of the clinic; sustainability of the clinic and its expansion.

 Justification

MDLCs improve patient outcomes [3,4,5,6,7,8]