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 .
Effect of postal prompts to patients and general practitioners on the quality of primary care after a coronary event (POST): randomised controlled trial
Abstract Objectives : To determine whether postal prompts to patients who have survived an acute coronary event and to their general practitioners improve secondary prevention of coronary heart disease . Design : R and omised controlled trial . Setting : 52 general practice s in east London , 44 of which had received facilitation of local guidelines for coronary heart disease . Participants : 328 patients admitted to hospital for myocardial infa rct ion or unstable angina . Interventions : Postal prompts sent 2 weeks and 3 months after discharge from hospital . The prompts contained recommendations for lowering the risk of another coronary event , including changes to lifestyle , drug treatment , and making an appointment to discuss these issues with the general practitioner or practice nurse . Main outcome measures : Proportion of patients in whom serum cholesterol concentrations were measured;proportion of patients prescribed β blockers ( 6 months after discharge ) ; and proportion of patients prescribed cholesterol lowering drugs ( 1 year after discharge ) . Results : Prescribing of β bockers ( odds ratio 1.7,95 % confidence interval 0.8 to 3.0 , P>0.05 ) and cholesterol lowering drugs ( 1.7 , 0.8 to 3.4 , P>0.05 ) did not differ between intervention and control groups . A higher proportion of patients in the intervention group ( 64 % ) than in the control group ( 38 % ) had their serum cholesterol concentrations measured ( 2.9 , 1.5 to 5.5 , P<0.001 ) . Secondary outcomes were significantly improved for consultations for coronary heart disease , the recording of risk factors , and advice given . There were no significant differences in patients ' self reported changes to lifestyle or to the belief that it is possible to modify the risk of another coronary event . Conclusions : Postal prompts to patients who had had acute coronary events and to their general practitioners in a locality where guidelines for coronary heart disease had been disseminated did not improve prescribing of effective drugs for secondary prevention or self reported changes to lifestyle . The prompts did increase consultation rates related to coronary heart disease and the recording of risk factors in the practice s. Effective secondary prevention of coronary heart disease requires more than postal prompts and the dissemination of guidelines
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 .