Choosing the preventive workload in general practice: Practical application of the Coronary Prevention Group guidelines and Dundee coronary risk-disk
Objective - To determine the workload implications for general practice of the Coronary Prevention Group and British Heart Foundation action plan for preventing heart disease. Design - Computer simulation of plan, including calculation of Dundee risk scores, with data from OXCHECK trial. Subjects - 4759 patients aged 35-64 who had health checks during 1989-91. Main outcome measure - Effect of using different risk scores as thresholds on workload and coverage of patients at known risk. Thresholds of 6-20 were used for cholesterol screening (nearset) and 4-16 for special care (preset). Results - On the basis of workload a nearset of 8 and preset of 12 would be reasonable. This implies cholesterol measurements in 1794 (37.7%) patients and special care in 1074 (22.6%). However, many patients with single risk factors were not allocated to special care at these thresholds: 11 (37.9%) patients with cholesterol concentrations ≥ 10 mmol/l, 21 (33.9%) with systolic pressure ≥ 180 mm Hg, and 213 (40.7%) heavy smokers (> 20 cigarettes/day) were missed. The distribution of scores was similar in those at established clinical risk, those with family history of heart disease, and others. Conclusion - The guidelines may help to make best use of resources within specific age-sex groups but sound protocols for unifactorial risk assessment and modification remain essential.