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The use of cardiovascular risk factor information in practice databases: making the best of patient data
1Senior lecturer in public health, University of Birmingham, Birmingham, UK. T.P.Marshall@bham.ac.uk
Insights
Primary care practices have sufficient cardiovascular risk factor data to implement targeted prevention strategies. The main barrier to cardiovascular prevention is not a lack of information, but rather its utilization.
Area of Science:
- Cardiovascular disease prevention
- Primary care research
- Health informatics
Background:
- Primary care teams collect cardiovascular risk factor data for patient identification and treatment.
- The extent of data availability and clinician utilization of this information remains unclear.
Purpose of the Study:
- To evaluate the completeness of recorded cardiovascular risk factor data in primary care.
- To determine the cost-effectiveness of using this data for identifying and treating eligible patients.
Main Methods:
- An Excel-based model was developed to assess incremental costs and benefits of cardiovascular risk assessment and treatment.
- Data from untreated, non-diabetic patients aged 35-74 years from two West Midlands general practices were analyzed.
- Completeness of risk factor data was assessed, and cost-benefit analysis was modeled for interventions.
Main Results:
- Blood pressure records were available for 72.9% and 77.7% of patients.
- 25.7% to 26.9% of patients were eligible for at least one treatment, most commonly aspirin or antihypertensives.
- Systematic assessment by cardiovascular risk identified 78% of eligible patients and 87% of preventable events within the top two risk deciles.
Conclusions:
- Insufficient risk factor information is not the primary obstacle to cardiovascular prevention.
- General practices possess adequate data to support efficient, targeted cardiovascular prevention strategies.
Background:
Primary care teams record cardiovascular risk factor data on their patients to help them identify and treat patients eligible for prevention. However, it is not known to what extent this information is already available to clinicians, or the extent to which it is used.
Aim:
To assess the extent to which risk factor is recorded, and to determine the cost-effectiveness of using recorded risk factor information in order to identify and treat eligible patients.
Design Of Study:
An Excel-based model of the incremental costs and benefits of assessment and treatment.
Setting:
Two general practices in the West Midlands.
Method:
Untreated, non-diabetic patients, aged 35-74 years, were identified from each practice, and risk factor data was uploaded into an Excel spreadsheet. The completeness of risk factor data was assessed. The costs and benefits of assessing and treating patients, in descending order of estimated cardiovascular risk, were then modelled.
Results:
In each practice, 72.9% and 77.7% of patients had a record of their blood pressure, 26.9% and 25.7% were eligible for at least one treatment: aspirin was the most common treatment followed by antihypertensives. With patients systematically assessed in descending order of cardiovascular risk, 78% of eligible patients and 87% of preventable cardiovascular events are found in the first two deciles of the target population.
Conclusions:
Lack of risk factor information is not the principal constraint on cardiovascular prevention. Practices have sufficient risk factor data to inform an efficient, targeted prevention strategy.
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