There were no significant effects of interventions on mean blood pressure or cholesterol levels , prescribing , smoking status or body mass index .
There was some suggestion of a " ceiling effect " whereby interventions have a diminishing beneficial effect once certain levels of risk factor management are reached .
There is weak evidence that regular planned recall of patients for appointments , structured monitoring of risk factors and prescribing , and education for patients can be effective in increasing the proportions of patients within target levels for cholesterol control and blood pressure .
BACKGROUND Ischaemic heart disease ( IHD ) is a major cause of mortality and morbidity and its prevalence is set to increase .
Secondary prevention aims to prevent subsequent acute events in people with established IHD .
While the benefits of individual medical and lifestyle interventions is established , the effectiveness of interventions which seek to improve the way secondary preventive care is delivered in primary care or community setting s is less so .
OBJECTIVES To assess the effectiveness of service organisation interventions , identifying which types and elements of service change are associated with most improvement in clinician and patient adherence to secondary prevention recommendations relating to risk factor levels and monitoring ( blood pressure , cholesterol and lifestyle factors such as diet , exercise , smoking and obesity ) and appropriate prophylactic medication .
Effects of sustained audit/feedback on self-reported health status of primary care patients.
PURPOSE Because limited audit/feedback of health status information has yielded mixed results , we evaluated the effects of a sustained program of audit/feedback on patient health and satisfaction . METHODS We conducted a group-r and omized effectiveness trial in which firms within Veterans Administration general internal medicine clinics served as units of r and omization , intervention , and analysis . Respondents to a baseline health inventory were regularly mailed the 36-Item Short Form ( SF-36 ) and , as relevant , question naires about six chronic conditions ( ischemic heart disease , diabetes , chronic obstructive pulmonary disease , depression , alcohol use , and hypertension ) and satisfaction with care . Data were reported to primary providers at individual patient visits and in aggregate during a 2-year period . RESULTS Baseline forms were mailed to 34,050 patients ; of the 22,413 respondents , 15,346 completed and returned follow-up surveys . Over the 2-year study , the difference between intervention and control groups ( as measured by difference in average slope ) was -0.26 ( 95 % confidence interval [ CI ] : -0.79 to 0.27 ; P=0.28 ) for the SF-36 Physical Component Summary score and -0.53 ( 95 % CI : -1.09 to 0.03 ; P=0.06 ) for the SF-36 Mental Component Summary score . No significant differences emerged after adjusting for deaths . There were no significant differences in condition-specific measures or satisfaction between groups after adjustment for provider type , panel size , and number of intervention visits , or after analysis of patients who completed all forms . CONCLUSION An elaborate , sustained audit/feedback program of general and condition-specific measures of health/satisfaction did not improve outcomes . To be effective , such data probably should be incorporated into a comprehensive chronic disease management program
There were no significant effects of interventions on mean blood pressure or cholesterol levels , prescribing , smoking status or body mass index .
There was some suggestion of a " ceiling effect " whereby interventions have a diminishing beneficial effect once certain levels of risk factor management are reached .
There is weak evidence that regular planned recall of patients for appointments , structured monitoring of risk factors and prescribing , and education for patients can be effective in increasing the proportions of patients within target levels for cholesterol control and blood pressure .
BACKGROUND Ischaemic heart disease ( IHD ) is a major cause of mortality and morbidity and its prevalence is set to increase .
Secondary prevention aims to prevent subsequent acute events in people with established IHD .
While the benefits of individual medical and lifestyle interventions is established , the effectiveness of interventions which seek to improve the way secondary preventive care is delivered in primary care or community setting s is less so .
OBJECTIVES To assess the effectiveness of service organisation interventions , identifying which types and elements of service change are associated with most improvement in clinician and patient adherence to secondary prevention recommendations relating to risk factor levels and monitoring ( blood pressure , cholesterol and lifestyle factors such as diet , exercise , smoking and obesity ) and appropriate prophylactic medication .