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 .
Improving pharmacotherapy after myocardial infarction by group academic detailing using feedback data on a patient level.
STUDY OBJECTIVE To develop and evaluate a peer review group ( PRG ) meeting using feedback data on a patient level to improve the quality of drug therapy for prevention of recurrent myocardial infa rct ion . DESIGN Prospect i ve follow-up study . DATA SOURCE General practitioners ' computerized patients records ( intervention patients ) and the PHARMO record linkage system  ( controls ) . PATIENTS Forty patients in the intervention group and 1030 control patients ; both groups had documented myocardial infa rct ion . INTERVENTION The intervention , which was based on the principles of group academic detailing , consisted of scoring current cardiovascular treatment on separate forms for each patient , presenting an overview of , and discussing , evidence -based treatment after myocardial infa rct ion , defining the target population , formulating a binding consensus , and identifying patients who were eligible for improvement of pharmacotherapy . MEASUREMENTS AND MAIN RESULTS Drug therapy and adherence to the newly formulated PRG consensus were assessed at baseline and 1 year after the intervention . Of the patients who received the intervention and were not treated according to the PRG consensus at baseline , 40 % received treatment according to the consensus 12 months after the PRG meeting . In the control group , the  proportion of patients was 9.5 % ( prevalence ratio 4.2 , 95 % confidence interval 1.8 - 9.7 ) . CONCLUSION Peer review group meetings can be a valuable tool for improving pharmacotherapy after myocardial infa rct ion
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 .