Service organisation for the secondary prevention of ischaemic heart disease in primary care

Buckley, Brian S; Byrne, Mary; Smith, Susan M

doi:10.1002/14651858.cd006772.pub2

Cited by 24 publications

(44 citation statements)

References 85 publications

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“…in CHD patients in primary care found limited evidence for effects on outcomes such as blood pressure and serum cholesterol levels. 26 In our explorative analysis of the relevance of various organisational domains, we found differential effects on performance. The components 'self-management support' and 'clinical information system' were found to be most consistently related to cardiovascular risk management.…”

Section: Resultsmentioning

confidence: 79%

What components of chronic care organisation relate to better primary care for coronary heart disease patients? An observational study

et al. 2012

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ObjectivesCardiovascular risk management (CVRM) received by patients shows large variation across countries. In this study we explored the aspects of primary care organisation associated with key components of CVRM in coronary heart disease (CHD) patients.DesignObservational study.Setting273 primary care practices in Austria, Belgium, England, Finland, France, Germany, The Netherlands, Slovenia, Switzerland and Spain.ParticipantsA random sample of 4563 CHD patients identified by coded diagnoses in eight countries, based on prescription lists and while visiting the practice in one country each.Main outcome measureWe performed an audit in primary care practices in 10 European countries. We used six indicators to measure key components of CVRM: risk factor recording, antiplatelet therapy, influenza vaccination, blood pressure levels (systolic <140 and diastolic <90 mm Hg), and low-density lipoprotein cholesterol <2.5 mmol/l. Data from structured questionnaires were used to construct an overall measure and six domain measures of practice organisation based on 39 items. Using multilevel regression analyses we explored the effects of practice organisation on CVRM, controlling for patient characteristics.ResultsBetter overall organisation of a primary care practice was associated with higher scores on three indicators: risk factor registration (B=0.0307, p<0.0001), antiplatelet therapy (OR 1.05, p=0.0245) and influenza vaccination (OR 1.12, p<0.0001). Overall practice organisation was not found to be related with recorded blood pressure or cholesterol levels. Only the organisational domains ‘self-management support’ and ‘use of clinical information systems’ were linked to three CVRM indicators.ConclusionsA better organisation of a primary care practice was associated with better scores on process indicators of CVRM in CHD patients, but not on intermediate patient outcome measures. Direct support for patients and clinicians seemed most influential.

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Section: Resultsmentioning

confidence: 79%

What components of chronic care organisation relate to better primary care for coronary heart disease patients? An observational study

et al. 2012

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“…The treatments usually involve medication therapy, promoting changes to a healthier lifestyle and participation in a cardiac rehabilitation (CR) program 9 . These secondary prevention strategies have been shown to be critical to management of the underlying disease and prevention of recurrent hospital admission and death [11][12][13] . In spite of the evidence, existing literature indicates that adherence to secondary prevention strategies is suboptimal [12][13][14] .…”

Section: Introductionmentioning

confidence: 99%

Regular Primary Care Plays a Significant Role in Secondary Prevention of Ischemic Heart Disease in a Western Australian Cohort

et al. 2011

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BACKGROUND: Secondary prevention for established ischaemic heart disease (IHD) involves medication therapy and a healthier lifestyle, but adherence is suboptimal. Simply having scheduled regular appointments with a primary care physician could confer a benefit for IHD patients possibly through increased motivation and awareness, but this has not previously been investigated in the literature. OBJECTIVE: To estimate the association between regular general practitioner (GP) visitation and rates of all-cause death, IHD death or repeat hospitalisation for IHD in older patients in Western Australia (WA). DESIGN: A retrospective cohort design. PARTICIPANTS: Patients aged≥65 years (n=31,841) with a history of hospitalisation for IHD from 1992-2006 were ascertained through routine health data collected on the entire WA population and included in the analysis. MAIN MEASURES: Frequency and regularity of GP visits was determined during a three-year exposure period at commencement of follow-up. A regularity score (range 0-1) measured the regularity of intervals between the GP visits and was divided into quartiles. Patients were then followed for a maximum of 11.5 years for outcome determination. Hazard ratios and 95% confidence intervals were calculated using Cox proportional hazards models. KEY RESULTS: Compared with the least regular quartile, patients with greater GP visit regularity had significantly decreased risks of all-cause death (2 nd least, 2 nd most and most regular: HR=0.76, 0.71 and 0.71); and IHD death (2 nd least, 2 nd most and most regular: HR=0.70, 0.68 and 0.65). Patients in the 2 nd least regular quartile also appeared to experience decreased risk of any repeat IHD hospitalisation (HR=0.83, 95%CI 0.71-0.96) as well as emergency hospitalisation (HR=0.81, 95%CI 0.67-0.98), compared with the least regular quartile. CONCLUSIONS: Some degree of regular GP visitation offers a small but significant protection against morbidity and mortality in older people with established IHD. The findings indicate the importance of scheduled, regular GP visits for the secondary prevention of IHD.KEY WORDS: ischemic heart disease; hospitalisations; GP visits; record linkage; primary care.

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“…The search was based on that used in the Cochrane Review in 2010, 5 and limited to articles published from 2007 onwards, with no language restrictions. One author screened the titles for eligibility.…”

Section: Search Strategy and Data Extractionmentioning

confidence: 99%

“…identified from the bibliography of the Cochrane Review, 5 the full text of 71 articles (56 studies) was reviewed ( Figure 1). Sixty articles (51 studies) were excluded, most commonly because the intervention was not based in primary care.…”

Section: How This Fits Inmentioning

confidence: 99%

Primary care organisational interventions for secondary prevention of ischaemic heart disease: a systematic review and meta-analysis

et al. 2015

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Service organisation for the secondary prevention of ischaemic heart disease in primary care

Cited by 24 publications

References 85 publications

What components of chronic care organisation relate to better primary care for coronary heart disease patients? An observational study

What components of chronic care organisation relate to better primary care for coronary heart disease patients? An observational study

Regular Primary Care Plays a Significant Role in Secondary Prevention of Ischemic Heart Disease in a Western Australian Cohort

Primary care organisational interventions for secondary prevention of ischaemic heart disease: a systematic review and meta-analysis

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