Table 5.

Primary care interventions that improve health outcomes and possible performance indicators that reflect their use

Intervention and possible indicators	Evidence that improved indicator value reflects improved health outcomes
Aspirin for patients at high risk of coronary or ischaemic cerebrovascular events
% of population with diagnosis of IHD	Yes, if appropriate treatment follows diagnosis. Need to compare observed and expected prevalence to estimate undetected IHD
% of population with diagnosis of IHD who take aspirin*	Yes, but need to ensure that observed prevalence of IHD is similar to expected. Need to record advice to buy aspirin
% of population with a diagnosis of ischaemic stroke or TIAs†	Yes, if appropriate treatment follows diagnosis. Need to compare observed and expected prevalence to estimate undetected stroke or TIAs
% of population with diagnosis of ischaemic stroke or TIAs who take aspirin*	Yes, but need to ensure that observed prevalence of stroke and TIAs is similar to expected. Need to record advice to buy aspirin
Control of hypertension
% of population whose BP recorded in past 5 years*†	Yes, if appropriate treatment follows diagnosis
% of population with diagnosis of hypertension	Yes, if appropriate treatment follows diagnosis. Need to compare observed and expected prevalence to estimate undetected hypertension
% of population identified as hypertensive whose most recent systolic BP <160 mm Hg*	Yes, but need to ensure that observed prevalence of hypertension is similar to expected
% of population identified as hypertensive whose most recent diastolic BP <90 mm Hg	Yes, but need to ensure that observed prevalence of hypertension is similar to expected
% of population identified as hypertensive whose BP recorded in past year†	Yes, if appropriate treatment follows a set of abnormal readings
% of those with diagnosis of IHD whose BP recorded in past year†	Yes, if appropriate treatment follows a set of abnormal readings
% of those with diagnosis of ischaemic stroke or TIA whose BP recorded in past year	Yes, if appropriate treatment follows a set of abnormal readings
Advice on stopping smoking or nicotine replacement therapy
% of population whose smoking status recorded	Yes, if appropriate treatment follows recording status as current smoker
% of population who are current smokers and have received advice on stopping smoking or nicotine replacement therapy	Yes
% of those with diagnosis of IHD whose smoking status recorded	Yes, if appropriate treatment follows recording status as current smoker
% of those with diagnosis of IHD who are current smokers who have received advice on stopping smoking or nicotine replacement therapy	Yes
% of those with a diagnosis of ischaemic stroke or TIA who have their smoking status recorded	Yes, if appropriate treatment follows recording status as current smoker
% of those with a diagnosis of ischaemic stroke or TIA who are current smokers who have received smoking cessation advice or nicotine replacement therapy	Yes
Use of angiotensin converting enzyme inhibitors in those with heart failure
% of population with a diagnosis of heart failure	Yes, if appropriate treatment follows diagnosis. Need to compare observed and expected prevalence to estimate undetected heart failure
% of population with heart failure who have a prescription for ACE inhibitors	Yes, if diagnosis is confirmed by echocardiography
Lipid lowering drugs for patients with established cardiovascular disease
% of those with a diagnosis of IHD who have had a cholesterol measurement	Yes, if appropriate treatment follows diagnosis
% of those with a diagnosis of IHD with a raised cholesterol who are prescribed lipid lowering drugs	Yes
Warfarin for stroke prophylaxis in NVAF
% of population with diagnosis of NVAF	Yes, if appropriate treatment follows diagnosis. Need to compare observed and expected prevalence to estimate undetected NVAF
% of general practice patients with diagnosis of NVAF who have a prescription for anticoagulants	Yes, need to ensure that observed prevalence of NVAF is similar to expected
Influenza vaccination in those aged over 65 years
% of population aged >65 who receive annual influenza vaccination	Yes

IHD=ischaemic heart disease; TIA=transient ischaemic attack; BP=blood pressure; ACE=angiotensin converting enzyme; NVAF=non-valvular atrial fibrillation 

All these indicators are attributable to health care. 

^*Similar indicators may be suggested by Department of Health commissioned expert groups examining a wide range of indicators for both stroke and myocardial infarction (M Goldacre, personal communication). 

^†Similar indicators presented in US National Library of Healthcare Indicators.¹¹