Cardiovascular risk management in patients with coronary heart disease in primary care

Variation across countries and practices. An observational study based on quality indicators

Jan Van Lieshout, Richard Grol, Stephen Campbell, Hector Falcoff, Eva Capell, Mathiaas Glehr, Margalit Goldfracht, Esko Kumpusalo, Beat Kunzi, Sabine Ludt, Davorina Petek, Veerle Vanderstighelen, Michel Wensing

Research output: Contribution to journalArticle

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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
Original languageEnglish
Pages (from-to)1-9
Number of pages9
JournalBMC Family Practice
Volume13
DOIs
Publication statusPublished - 2012
Externally publishedYes

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Risk Management
Observational Studies
Coronary Disease
Primary Health Care
Blood Pressure
Slovenia
Multilevel Analysis
Urbanization
Platelet Aggregation Inhibitors
LDL Cholesterol
Human Influenza
Vaccination
Cholesterol
Regression Analysis
Exercise

Cite this

Van Lieshout, Jan ; Grol, Richard ; Campbell, Stephen ; Falcoff, Hector ; Capell, Eva ; Glehr, Mathiaas ; Goldfracht, Margalit ; Kumpusalo, Esko ; Kunzi, Beat ; Ludt, Sabine ; Petek, Davorina ; Vanderstighelen, Veerle ; Wensing, Michel. / Cardiovascular risk management in patients with coronary heart disease in primary care : Variation across countries and practices. An observational study based on quality indicators. In: BMC Family Practice. 2012 ; Vol. 13. pp. 1-9.
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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",
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Van Lieshout, J, Grol, R, Campbell, S, Falcoff, H, Capell, E, Glehr, M, Goldfracht, M, Kumpusalo, E, Kunzi, B, Ludt, S, Petek, D, Vanderstighelen, V & Wensing, M 2012, 'Cardiovascular risk management in patients with coronary heart disease in primary care: Variation across countries and practices. An observational study based on quality indicators', BMC Family Practice, vol. 13, pp. 1-9. https://doi.org/10.1186/1471-2296-13-96

Cardiovascular risk management in patients with coronary heart disease in primary care : Variation across countries and practices. An observational study based on quality indicators. / Van Lieshout, Jan; Grol, Richard; Campbell, Stephen; Falcoff, Hector; Capell, Eva; Glehr, Mathiaas; Goldfracht, Margalit; Kumpusalo, Esko; Kunzi, Beat; Ludt, Sabine; Petek, Davorina; Vanderstighelen, Veerle; Wensing, Michel.

In: BMC Family Practice, Vol. 13, 2012, p. 1-9.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Cardiovascular risk management in patients with coronary heart disease in primary care

T2 - Variation across countries and practices. An observational study based on quality indicators

AU - Van Lieshout, Jan

AU - Grol, Richard

AU - Campbell, Stephen

AU - Falcoff, Hector

AU - Capell, Eva

AU - Glehr, Mathiaas

AU - Goldfracht, Margalit

AU - Kumpusalo, Esko

AU - Kunzi, Beat

AU - Ludt, Sabine

AU - Petek, Davorina

AU - Vanderstighelen, Veerle

AU - Wensing, Michel

PY - 2012

Y1 - 2012

N2 - 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

AB - 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

U2 - 10.1186/1471-2296-13-96

DO - 10.1186/1471-2296-13-96

M3 - Article

VL - 13

SP - 1

EP - 9

JO - BMC Family Practice

JF - BMC Family Practice

SN - 1471-2296

ER -