Cardiovascular risk management in patients with coronary heart disease in primary care : variation across countries and practices. An observational study based on quality indicators
van Lieshout, Jan (Radboud University Nijmegen Medical Centre. Scientific Institute for Quality of Health Care (Nijmegen, Països Baixos))
Grol, Richard (Radboud University Nijmegen Medical Centre. Scientific Institute for Quality of Health Care (Nijmegen, Països Baixos))
Campbell, Stephen (University of Manchester. Health Sciences - Primary Care Research Group (Manchester, Regne Unit))
Falcoff, Hector (Université Paris Descartes. Département de Médecine Générale)
Frigola-Capell, Eva (Universitat Autònoma de Barcelona. Institut Universitari Avedis Donabedian)
Glehr, Mathias (Medical University of Graz. Department of Orthopedic Surgery (Graz, Àustria))
Goldfracht, Margalit (Clalit Health Services (Tel Aviv, Israel))
Kumpusalo, Esko (University of Eastern Finland, Department of Public Health and General Practice (Kuopio, Finlàndia))
Künzi, Beat (Swisspep Institut für Qualität und Forschung im Gesundheitswesen (Berna, Suïssa))
Ludt, Sabine (University of Heidelberg. Department of General Practice and Health Services Research (Heildelberg, Alemanya))
Petek, Davorina (Zdravje Medical Center (Ljubljana, Eslovènia))
Vanderstighelen, Veerle (Domus Medica (Berchem, Bèlgica))
Wensing, Michel (Radboud University Nijmegen Medical Centre. Scientific Institute for Quality of Health Care (Nijmegen, Països Baixos))

Date:	2012
Abstract:	Background: Primary care has an important role in cardiovascular risk management (CVRM) and a minimum size of scale of primary care practices may be needed for efficient delivery of CVRM . We examined CVRM in patients with coronary heart disease (CHD) in primary care and explored the impact of practice size. Methods: In an observational study in 8 countries we sampled CHD patients in primary care practices and collected data from electronic patient records. Practice samples were stratified according to practice size and urbanisation; patients were selected using coded diagnoses when available. CVRM was measured on the basis of internationally validated quality indicators. In the analyses practice size was defined in terms of number of patients registered of visiting the practice. We performed multilevel regression analyses controlling for patient age and sex. Results: We included 181 practices (63% of the number targeted). Two countries included a convenience sample of practices. Data from 2960 CHD patients were available. Some countries used methods supplemental to coded diagnoses or other inclusion methods introducing potential inclusion bias. We found substantial variation on all CVRM indicators across practices and countries. We computed aggregated practice scores as percentage of patients with a positive outcome. Rates of risk factor recording varied from 55% for physical activity as the mean practice score across all practices (sd 32%) to 94% (sd 10%) for blood pressure. Rates for reaching treatment targets for systolic blood pressure, diastolic blood pressure and LDL cholesterol were 46% (sd 21%), 86% (sd 12%) and 48% (sd 22%) respectively. Rates for providing recommended cholesterol lowering and antiplatelet drugs were around 80%, and 70% received influenza vaccination. Practice size was not associated to indicator scores with one exception: in Slovenia larger practices performed better. Variation was more related to differences between practices than between countries. Conclusions: CVRM measured by quality indicators showed wide variation within and between countries and possibly leaves room for improvement in all countries involved. Few associations of performance scores with practice size were found.
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Language:	Anglès
Document:	Article ; Versió publicada
Published in:	BMC family practice, Vol. 13, N. 96 (October 2012) , p. 1-9, ISSN 1471-2296

DOI: 10.1186/1471-2296-13-96
PMID: 23035928

9 p, 189.2 KB

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Research literature > UAB research groups literature > Research Centres and Groups (research output) > Health sciences and biosciences > Avedis Donabedian Research Institute-UAB
Articles > Published articles