Avtor/Urednik		Van Lieshout, Jan; Grol, Richard; Campbell, Stephen; Falcoff, Hector; Frigola-Capell, Eva; Glehr, Mathias; Goldfracht, Margalit; Kumpusalo, Esko; Kuenzi, Beat; Petek, Davorina
Naslov		Cardiovascular risk management in patients with coronary heart disease in primary care: variation across countries and practices. an observational study based on quality indicators
Tip		članek
Vir		BMC Fam Pract
Vol. in št.		Letnik 13, št. 1
Leto izdaje		2012
Obseg		str. 96
Jezik		eng
Abstrakt		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. (Abs. trunc. at 2000 ch.)
Deskriptorji		CORONARY DISEASE PRIMARY HEALTH CARE RISK FACTORS MEDICAL RECORDS QUALITY OF HEALTH CARE REGRESSION ANALYSIS MULTICENTER STUDIES