Cardiovascular risk management in patients with coronary heart disease in primary care : variation across countries and practices. An observational study based on quality indicators
| Autor: | Eva Frigola Capell, Sabine Ludt, Michel Wensing, Margalit Goldfracht, Veerle Vanderstighelen, Richard Grol, Stephen Campbell, Jan van Lieshout, Hector Falcoff, Mathias Glehr, Davorina Petek, Beat Künzi, Esko Kumpusalo |
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| Rok vydání: | 2021 |
| Předmět: |
Male
Pediatrics medicine.medical_specialty Cross-sectional study Implementation Science [NCEBP 3] MEDLINE Coronary Disease DCN PAC - Perception action and control Risk Factors Health care medicine Secondary Prevention Humans Disease management (health) Risk factor Practice Patterns Physicians' Aged Quality Indicators Health Care Retrospective Studies lcsh:R5-920 Primary Health Care business.industry Disease Management Retrospective cohort study Europe Blood pressure Cross-Sectional Studies Outcome and Process Assessment Health Care Observational study Female lcsh:Medicine (General) Family Practice business Demography Research Article |
| Zdroj: | Recercat: Dipósit de la Recerca de Catalunya Varias* (Consorci de Biblioteques Universitáries de Catalunya, Centre de Serveis Científics i Acadèmics de Catalunya) BMC Family Practice Recercat. Dipósit de la Recerca de Catalunya instname BMC Family Practice, Vol 13, Iss 1, p 96 (2012) Dipòsit Digital de Documents de la UAB Universitat Autònoma de Barcelona BMC Family Practice, 13 |
| ISSN: | 1471-2296 |
| Popis: | Contains fulltext : 110491.pdf (Publisher’s version ) (Open Access) 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. |
| Databáze: | OpenAIRE |
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