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 .
Selection bias in enrollment to a programme aimed at the secondary prevention of ischaemic heart disease in general practice: a cohort study.
OBJECTIVE To evaluate differences between adults who participated in a secondary prevention of ischaemic heart disease ( IHD ) programme and those who did not . DESIGN Population -based cohort study . SETTING A r and om selection of 12 Irish general practice s. PARTICIPANTS A total of 493 adults with IHD identified in 2000/2001 . INTERVENTION Medical records search and postal question naires in 2000/2001 and 2005/2006 . MAIN OUTCOME MEASURES Differences in demographic characteristics and indicators of process of care and risk factor management between participants and non- participants . RESULTS Multiple logistic regression confirmed that female gender was associated with a reduced likelihood of participation in the secondary prevention programme [ odds ratio ( OR ) 0.53 ( 95 % CI : 0.32 - 0.87 ) ] , while an adequately controlled total cholesterol level was associated with an increased likelihood of enrollment [ OR 1.82 ( 95 % CI : 1.18 - 2.80 ) ] . CONCLUSIONS There is limited evidence that biases , which have been shown to affect participation in research , also affect participation in care programmes in everyday practice . A gender bias appears to have affected the enrollment of participants for the secondary preventive programme considered by this study , with enrollment favouring men with well-managed cholesterol . Reimbursement dependent upon patient adherence may incentivise the enrollment of adherent patients , although the influence of patient choice is unclear : the need to maintain records relating to patients who opt out of such interventions is thus highlighted
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 .