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• W1623367078 abstract "Background: Primary care has an important role in cardiovascular risk management (CVRM) and a minimum size of scale of primary care practices may be needed for efficient delivery of CVRM. We examined CVRM in patients with coronary heart disease (CHD) in primary care and explored the impact of practice size. Methods: In an observational study in 8 countries we sampled CHD patients in primary care practices and collected data from electronic patient records. Practice samples were stratified according to practice size and urbanization; patients were selected using coded diagnoses when available. CVRM was measured on the basis of internationally validated quality indicators. In the analyses practice size was defined in terms of number of patients registered of visiting the practice. We performed multilevel regression analyses controlling for patient age and sex. Results: We included 181 practices (63% of the number targeted). Two countries included a convenience sample of practices. Data from 2960 CHD patients were available. Some countries used methods supplemental to coded diagnoses or other inclusion methods introducing potential inclusion bias. We found substantial variation on all CVRM indicators across practices and countries. We computed aggregated practice scores as percentage of patients with a positive outcome. Rates of risk factor recording varied from 55% for physical activity as the mean practice score across all practices (SD 32%) to 94% (SD 10%) for blood pressure. Rates for reaching treatment targets for systolic blood pressure, diastolic blood pressure and LDL cholesterol were 46% (SD 21%), 86% (SD 12%) and 48% (SD 22%) respectively. Rates for providing recommended cholesterol lowering and antiplatelet drugs were around 80%, and 70% received influenza vaccination. Practice size was not associated to indicator scores with one exception: in Slovenia larger practices performed better. Variation was more related to differences between practices than between countries. Conclusions: CVRM measured by quality indicators showed wide variation within and between countries and possibly leaves room for improvement in all countries involved. Few associations of performance scores with practice size were found. Cardiovascular risk management in patients with coronary heart disease 23 Background Many patients with chronic conditions are treated in primary care. This is challenging as high quality chronic care asks for an organizational structure allowing for population-based management. In previous research larger practice size tented to be related to higher quality of care considering various conditions with greater diversity of services. Furthermore, larger practices tended to show more features consistent with the delivery of chronic care. In many countries there is a tendency to develop larger practices. Increasing size of scale and scope may be, up to a certain point, associated with decreasing average costs of a service as fixed costs like participation in continued education and hiring additional staff are divided by a larger number of patients. From an educational perspective, a larger size of scale with more patients may be associated with larger opportunity to practice specific procedures, thus steeper learning curves and higher quality of performance. On the other hand, a smaller practice size may have advantages in terms of more personal care and continuity. Cardiovascular diseases (CVD) have major impact on the mortality and healthrelated quality of life of people in both developed and developing countries. Despite a declining cardiovascular mortality, improvements in the preventive, medical and surgical treatment in previous decades, and widely accepted practice guidelines, CVD are still one of the major causes of death and illness. Primary care can play an important role in delivering cardiovascular risk management (CVRM) to populations, but previous research showed that not all eligible patients receive optimal prevention of atherosclerosis-related CVD. Many European countries therefore have adopted large scale programs for improving cardiovascular risk management, including pay-for-performance in the United Kingdom, disease management in Germany and practice accreditation in the Netherlands. While data on CVRM are collected in a number of countries, mostly in specialized care settings, comparable data from primary care where many patients are treated and counselled, was lacking. We conducted an observational study of current CVRM in primary care in eight European countries, focused on patients with established coronary heart diseases (CHD). In this paper we aimed to describe current practice across countries and to explore associations of practice size with CVRM measured by quality indicators." @default.
• W1623367078 created "2016-06-24" @default.
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• W1623367078 date "2014-01-01" @default.
• W1623367078 modified "2023-09-24" @default.
• W1623367078 title "Exploring quality and outcomes of cardiovascular primary care in Catalonia." @default.
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