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Lowering Cholesterol and Lowering Costs-Reply

Judy Shaffer, RN; Laura F. Wexler, MD
Arch Intern Med. 1996;156(13):1479. doi:10.1001/archinte.1996.00440120142020.
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We thank Bachman for his thoughtful reading of our article. He addresses the concern of many primary care providers that augmenting traditional physician-based care with multidisciplinary providers will lead to "fragmentation of care," especially in those patients with comorbid problems. We believe that the success of the LIP team was to a large degree attributable to the individualized plan implemented by skilled (and unhurried) patient educators, eg, nurses, dietitians, clinical pharmacists, and health psychologists, who could fully implement all aspects of the National Cholesterol Education Program (NCEP) guidelines, which include a major component of patient education as well as recommendations for drug use. Our multidisciplinary team was able to identify comorbid problems (in some cases overlooked by busy, "chief complaint"— oriented physicians) by using the detailed screening approach in the NCEP guidelines; newly diagnosed problems (eg, diabetes mellitus and hypothyroidism) were referred back to the primary care physician, who continued

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