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 .
A randomised controlled trial of joint consultations with general practitioners and cardiologists in primary care.
BACKGROUND Joint consultation sessions of a small group of general practitioners ( GPs ) and a specialist in orthopaedics proved to be an effective way of decreasing the referral rate of orthopaedic patients . Cardiac complaints comprise an important category of health problems with high referral rates . AIMS To study the effects of joint consultation on the quality of care and referrals for patients with cardiac complaints . DESIGN OF STUDY R and omised controlled trial . SETTING Forty-nine GPs participated in 16 consultation groups , each with one of 13 cardiologists , in monthly joint consultations  over a period of about 18 months . METHOD The GPs selected patients about whom they were uncertain , and those needing urgent referral were excluded . Patients were r and omly assigned to joint consultation or to usual care . After a follow-up period all patients had a joint consultation for outcome assessment . Referral data were provided by two regional health insurance companies and question naires were given to the patients , GPs , and cardiologists to gauge their opinion of the trial . RESULTS One hundred and forty-eight patients in the intervention group and 158 patients in the control group fulfilled the whole protocol . The quality of care was similar in both groups . In the intervention group , 34 % of the patients were referred , compared with 55 % in the control group ( P = 0.001 ) , and fewer patients underwent further diagnostic procedures ( 7 % compared with 16 % , P = 0.013 ) . Referrals to cardiology as a proportion of all referrals decreased in the practice s of the participating GPs , compared with their reference districts ( P = 0.024 ) . CONCLUSION Joint consultation is an effective method that provides a quality of care that at least equals usual care and that contributes to a better selection of patients who need specialist care
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 .