Audit-based education to reduce suboptimal management of cholesterol in primary care: A before and after study
De Lusignan S., Belsey J., Hague N., Dhoul N., Van Vlymen J.
Background: Statins are recommended for the secondary prevention of cardiovascular disease, although they are often used in suboptimal doses and some patients may not receive lipid-lowering therapy. The Primary Care Data Quality (PCDQ) programme is an audit-based educational intervention. Objective: To report the PCDQ programme's effect on the cholesterol management in cardiovascular disease. Subjects and methods: Anonymized general practice data from 99 practices; 5% (n = 29 915) had cardiovascular diagnoses. Results: Mean cholesterol fell from 4.75 to 4.64 mmol l-1; patients achieving cholesterol target (< 5 mmol l-1) rose from 45.3 to 53.2%. Coronary heart disease patients achieved better control (mean 4.57 mmol l -1) than those with stroke (4.87 mmol l-1) or peripheral vascular disease (4.93 mmol l-1). Statin prescribing increased from 57.5 to 62.7%. Patients with diabetes [odds ratio (OR) 2.06, 95% confidence interval (95% CI) 1.91-2.21], prior myocardial infarction (MI) (OR 1.93, 95% CI 1.80-2.07), revascularization (OR 1.52, 95% CI 1.33-1.73) and smokers (OR 1.31, 95% CI 1.23-1.39) were more likely to receive statins, whereas people aged 75+ (OR 0.48, 95% CI 0.45-0.50), females (OR 0.90, 95% CI 0.86-0.94) and non-CHD-diagnosed (OR 0.36, 95% CI 0.34-0.38) were less likely. Conclusions: Diagnostic coding and number of patients who had their cholesterol measured and treated increased. There was no significant change in dosage used or inequity between the different groups prescribed statins. © The Author 2006, Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved.