TY - JOUR
T1 - Evaluating quality and its determinants in lipid control for secondary prevention of heart disease and stroke in primary care
T2 - A study in an inner London Borough
AU - Dodhia, Hiten
AU - Kun, Liu
AU - Ellis, Hugh Logan
AU - Crompton, James
AU - Wierzbicki, Anthony S.
AU - Williams, Helen
AU - Hodgkinson, Anna
AU - Balazs, John
PY - 2015
Y1 - 2015
N2 - Objectives: To assess quality of management and determinants in lipid control for secondary prevention of cardiovascular disease (CVD) using multilevel regression models. Design: Cross-sectional study. Setting: Inner London borough, with a primary care registered population of 378 000 (2013). Participants: 48/49 participating general practices with 7869 patients on heart disease/stroke registers were included. Outcome measures: (1) Recording of current total cholesterol levels and lipid control according to national evidence-based standards. (2) Assessment of quality by age, sex, ethnicity, deprivation, presence of other risks or comorbidity in meeting both lipid measurement and control standards. Results: Some process standards were not met. Patients with a current cholesterol measurement >5 mmol/L were less likely to have a current statin prescription (adjusted OR=3.10; 95% CI 2.70 to 3.56). They were more likely to have clustering of other CVD risk factors. Women were significantly more likely to have raised cholesterol after adjustment for other factors (adjusted OR=1.74; 95% CI 1.53 to 1.98). Conclusions: In this study, the key factor that explained poor lipid control in people with CVD was having no current prescription record of a statin. Women were more likely to have poorly controlled cholesterol (independent of comorbid risk factors and after adjusting for age, ethnicity, deprivation index and practice-level variation). Women with CVD should be offered statin prescription and may require higher statin dosage for improved control.
AB - Objectives: To assess quality of management and determinants in lipid control for secondary prevention of cardiovascular disease (CVD) using multilevel regression models. Design: Cross-sectional study. Setting: Inner London borough, with a primary care registered population of 378 000 (2013). Participants: 48/49 participating general practices with 7869 patients on heart disease/stroke registers were included. Outcome measures: (1) Recording of current total cholesterol levels and lipid control according to national evidence-based standards. (2) Assessment of quality by age, sex, ethnicity, deprivation, presence of other risks or comorbidity in meeting both lipid measurement and control standards. Results: Some process standards were not met. Patients with a current cholesterol measurement >5 mmol/L were less likely to have a current statin prescription (adjusted OR=3.10; 95% CI 2.70 to 3.56). They were more likely to have clustering of other CVD risk factors. Women were significantly more likely to have raised cholesterol after adjustment for other factors (adjusted OR=1.74; 95% CI 1.53 to 1.98). Conclusions: In this study, the key factor that explained poor lipid control in people with CVD was having no current prescription record of a statin. Women were more likely to have poorly controlled cholesterol (independent of comorbid risk factors and after adjusting for age, ethnicity, deprivation index and practice-level variation). Women with CVD should be offered statin prescription and may require higher statin dosage for improved control.
UR - http://www.scopus.com/inward/record.url?scp=84960116266&partnerID=8YFLogxK
U2 - 10.1136/bmjopen-2015-008678
DO - 10.1136/bmjopen-2015-008678
M3 - Article
C2 - 26656014
AN - SCOPUS:84960116266
SN - 2044-6055
VL - 5
JO - BMJ Open
JF - BMJ Open
IS - 12
M1 - e008678
ER -
