Abstract
Objectives—Evaluation of the effect of a quality improvement programme on cardiovascular disease (CVD) risk factor recording and risk factor levels in a controlled study at two primary health care centres serving 26 000 inhabitants in Northern Helsinki.
Methods—From a random sample of patient records from 1995 (n=1066), 1996 (n=1042), and 1997 (n=1040) the frequency of CVD risk factor recording was measured and the changes in mean levels of total cholesterol, blood glucose, blood pressure, and body weight were monitored during the follow up period. The intervention programme (1995–1996) consisted of lectures and meetings of multiprofessional teams, development of local guidelines, and introduction of a structured risk factor recording sheet as part of the patient records.
Results—After the quality improvement period all risk factors were better recorded at the intervention station than at the control station (p<0.001). More high risk CVD patients were detected from the general population at the intervention station. The mean values of most measured risk factors changed during the intervention. During the follow up period differences were observed between the two health stations in the time trends for body weight, body mass index (BMI), total cholesterol, and glucose levels. Risk factor levels of high risk patients receiving CVD treatment decreased during the intervention.
Conclusions—A simple quality improvement programme improved the practice of recording risk factors for CVD which resulted in earlier detection of patients with a high risk of developing the disease.
Key Words: quality improvement; cardiovascular disease; risk factor recording; primary health care
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Selected References
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- Eaton C. B., McQuade W., Glupczynski D. A comparison of primary versus secondary cardiovascular disease prevention in an academic family practice. Fam Med. 1994 Oct;26(9):587–592. [PubMed] [Google Scholar]
- Fullard E., Fowler G., Gray M. Promoting prevention in primary care: controlled trial of low technology, low cost approach. Br Med J (Clin Res Ed) 1987 Apr 25;294(6579):1080–1082. doi: 10.1136/bmj.294.6579.1080. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Garber A. M., Browner W. S., Hulley S. B. Cholesterol screening in asymptomatic adults, revisited. Part 2. Ann Intern Med. 1996 Mar 1;124(5):518–531. doi: 10.7326/0003-4819-124-5-199603010-00013. [DOI] [PubMed] [Google Scholar]
- Grol R. Personal paper. Beliefs and evidence in changing clinical practice. BMJ. 1997 Aug 16;315(7105):418–421. doi: 10.1136/bmj.315.7105.418. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Grover S. A., Lowensteyn I., Esrey K. L., Steinert Y., Joseph L., Abrahamowicz M. Do doctors accurately assess coronary risk in their patients? Preliminary results of the coronary health assessment study. BMJ. 1995 Apr 15;310(6985):975–978. doi: 10.1136/bmj.310.6985.975. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Hellénius M. L., de Faire U., Krakau I., Berglund B. Prevention of cardiovascular disease within the primary health care system--feasibility of a prevention programme within the Sollentuna primary health care catchment area. Scand J Prim Health Care. 1993 Mar;11(1):68–73. doi: 10.3109/02813439308994905. [DOI] [PubMed] [Google Scholar]
- Ketola E., Sipilä R., Mäkelä M. Effectiveness of individual lifestyle interventions in reducing cardiovascular disease and risk factors. Ann Med. 2000 May;32(4):239–251. doi: 10.3109/07853890009011767. [DOI] [PubMed] [Google Scholar]
- Kurji K. H., Haines A. P. Detection and management of hypertension in general practices in north west London. Br Med J (Clin Res Ed) 1984 Mar 24;288(6421):903–906. doi: 10.1136/bmj.288.6421.903. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Leaf D. A., Neighbor W. E., Schaad D., Scott C. S. A comparison of self-report and chart audit in studying resident physician assessment of cardiac risk factors. J Gen Intern Med. 1995 Apr;10(4):194–198. doi: 10.1007/BF02600254. [DOI] [PubMed] [Google Scholar]
- Maitland J. M., Reid J., Taylor R. J. Two stage audit of cerebrovascular and coronary heart disease risk factor recording: the effect of case finding and screening programmes. Br J Gen Pract. 1991 Apr;41(345):144–146. [PMC free article] [PubMed] [Google Scholar]
- Meagher P. F., Deery C., Linton A. F., Craig T. J., Leeson P. J. An audit of hypertensive care in general practice. Ir Med J. 1993 Jan;86(1):20–22. [PubMed] [Google Scholar]
- Pringle M. Preventing ischaemic heart disease in one general practice: from one patient, through clinical audit, needs assessment, and commissioning into quality improvement. BMJ. 1998 Oct 24;317(7166):1120–1124. doi: 10.1136/bmj.317.7166.1120. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Shepherd J., Cobbe S. M., Ford I., Isles C. G., Lorimer A. R., MacFarlane P. W., McKillop J. H., Packard C. J. Prevention of coronary heart disease with pravastatin in men with hypercholesterolemia. West of Scotland Coronary Prevention Study Group. N Engl J Med. 1995 Nov 16;333(20):1301–1307. doi: 10.1056/NEJM199511163332001. [DOI] [PubMed] [Google Scholar]
- Skinner J. S., Farrer M., Albers C. J., Adams P. C. Risk factor control five years after coronary bypass grafting. J R Coll Physicians Lond. 1996 Mar-Apr;30(2):136–141. [PMC free article] [PubMed] [Google Scholar]
- Wilhelmsen L., Strasser T. WHO-WHL Hypertension Management Audit Project. J Hum Hypertens. 1993 Jun;7(3):257–263. [PubMed] [Google Scholar]