S de Lusignan1, J Belsey, N Hague, N Dhoul, J van Vlymen. 1. Primary Care Informatics, Division of Community Health Sciences, St George's - University of London, London SW17 ORE, UK. slusigna@sgul.ac.uk
Abstract
BACKGROUND: Statins are recommended for the secondary prevention of cardiovascular disease, although they are often used in suboptimal doses and some patients may not receive lipid-lowering therapy. The Primary Care Data Quality (PCDQ) programme is an audit-based educational intervention. OBJECTIVE: To report the PCDQ programme's effect on the cholesterol management in cardiovascular disease. Subjects and methods Anonymized general practice data from 99 practices; 5% (n = 29 915) had cardiovascular diagnoses. RESULTS: Mean cholesterol fell from 4.75 to 4.64 mmol l(-1); patients achieving cholesterol target (< 5 mmol l(-1)) rose from 45.3 to 53.2%. Coronary heart disease patients achieved better control (mean 4.57 mmol l(-1)) than those with stroke (4.87 mmol l(-1)) or peripheral vascular disease (4.93 mmol l(-1)). Statin prescribing increased from 57.5 to 62.7%. Patients with diabetes [odds ratio (OR) 2.06, 95% confidence interval (95% CI) 1.91-2.21], prior myocardial infarction (MI) (OR 1.93, 95% CI 1.80-2.07), revascularization (OR 1.52, 95% CI 1.33-1.73) and smokers (OR 1.31, 95% CI 1.23-1.39) were more likely to receive statins, whereas people aged 75+ (OR 0.48, 95% CI 0.45-0.50), females (OR 0.90, 95% CI 0.86-0.94) and non-CHD-diagnosed (OR 0.36, 95% CI 0.34-0.38) were less likely. CONCLUSIONS: Diagnostic coding and number of patients who had their cholesterol measured and treated increased. There was no significant change in dosage used or inequity between the different groups prescribed statins.
BACKGROUND: Statins are recommended for the secondary prevention of cardiovascular disease, although they are often used in suboptimal doses and some patients may not receive lipid-lowering therapy. The Primary Care Data Quality (PCDQ) programme is an audit-based educational intervention. OBJECTIVE: To report the PCDQ programme's effect on the cholesterol management in cardiovascular disease. Subjects and methods Anonymized general practice data from 99 practices; 5% (n = 29 915) had cardiovascular diagnoses. RESULTS: Mean cholesterol fell from 4.75 to 4.64 mmol l(-1); patients achieving cholesterol target (< 5 mmol l(-1)) rose from 45.3 to 53.2%. Coronary heart diseasepatients achieved better control (mean 4.57 mmol l(-1)) than those with stroke (4.87 mmol l(-1)) or peripheral vascular disease (4.93 mmol l(-1)). Statin prescribing increased from 57.5 to 62.7%. Patients with diabetes [odds ratio (OR) 2.06, 95% confidence interval (95% CI) 1.91-2.21], prior myocardial infarction (MI) (OR 1.93, 95% CI 1.80-2.07), revascularization (OR 1.52, 95% CI 1.33-1.73) and smokers (OR 1.31, 95% CI 1.23-1.39) were more likely to receive statins, whereas people aged 75+ (OR 0.48, 95% CI 0.45-0.50), females (OR 0.90, 95% CI 0.86-0.94) and non-CHD-diagnosed (OR 0.36, 95% CI 0.34-0.38) were less likely. CONCLUSIONS: Diagnostic coding and number of patients who had their cholesterol measured and treated increased. There was no significant change in dosage used or inequity between the different groups prescribed statins.
Authors: Simon de Lusignan; Hugh Gallagher; Tom Chan; Nicki Thomas; Jeremy van Vlymen; Michael Nation; Neerja Jain; Aumran Tahir; Elizabeth du Bois; Iain Crinson; Nigel Hague; Fiona Reid; Kevin Harris Journal: Implement Sci Date: 2009-07-14 Impact factor: 7.327
Authors: Imran Rafi; Susmita Chowdhury; Tom Chan; Ibrahim Jubber; Mohammad Tahir; Simon de Lusignan Journal: BMC Fam Pract Date: 2013-07-24 Impact factor: 2.497
Authors: Simon de Lusignan; Simon de Lusignana; Hugh Gallagher; Simon Jones; Tom Chan; Jeremy van Vlymen; Aumran Tahir; Nicola Thomas; Neerja Jain; Olga Dmitrieva; Imran Rafi; Andrew McGovern; Kevin Harris Journal: Kidney Int Date: 2013-03-27 Impact factor: 10.612