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 .
An educational intervention to improve data recording in the management of ischaemic heart disease in primary care.
BACKGROUND Gaps in computerized medical records and a lack of a systematic approach to data recording make progress towards achieving quality st and ards in primary care difficult to demonstrate . The aim of this study was to examine the effect of an educational intervention on data quality in primary care . METHODS A before- and -after study of key data quality measures was carried out in 87 general practice s in eight primary care organizations in Engl and in phase 1 and 84 general practice s in phase 2 . The subjects were 19,470 patients with ischaemic heart disease in phase 1 and 19,784 patients in phase 2 . The main outcome measures were improvement in the completeness and quality of the computerized medical record . Anonymized data were extracted from clinical information systems and processed to produce comparative information on each practice . Data quality workshops were arranged , in which reflection can take place , backed up by summary statistics . Practice visits provided training and personalized feedback of patients needing intervention . RESULTS In the patients with heart disease , nearly 16,000 new clinical entries were made in the key improvement areas . The percentage of patients advised to quit smoking increased by 49.3 per cent , from 23.6 per cent to 61.9 per cent . There were also significant improvements in many other aspects of management . CONCLUSION Focused interventions that provide targeted and relevant clinical information can be implemented in primary care . Such interventions can lead to a rise in data quality in primary care , but their effectiveness needs to be further tested in more rigorous research setting s such as r and omized controlled trials
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 .