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Organisational determinants of cardiovascular prevention in general practice
Claudia M Lobo1, Bernard D Frijling, Marlies E J L Hulscher
1Department of General Practice, Erasmus University Rotterdam, Rotterdam, The Netherlands.
Objective:
To assess organisational determinants in the prevention of cardiovascular disease.
Design:
A cross-sectional study.
Setting And Subjects:
130 general practices in The Netherlands. Data were collected using questionnaires. A causal model was designed and analysed by path analysis.
Main Outcome Measures:
Relationships between preventive activities, practice management and practice characteristics.
Results:
Important differences between adequacy of equipment and practice organisation were found. Record-keeping was significantly better when working experience of the GPs was less than 15 years, when the practice consisted only of female GPs, and when the practice had written protocols for cardiovascular disease management and the staff held regular scheduled meetings (teamwork). Teamwork also showed a significant relation with follow-up activities. The influence of non-measured variables in the model was considerable.
Conclusion:
In exploring the organisational setting as a barrier to prevention and disease management, the designed model showed no major effects. Despite the wide variety of practice organisational items investigated, a strong influence of non-measured variables was evident. Teamwork in the practices proved to be related to both follow-up and record-keeping. Younger and female GPs were further predictors of adequate record-keeping.