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Gaps in primary care documentation of cardiovascular risk factors
Natasha Rafter1, Susan Wells, Alistair Stewart
1Clinical Trials Research Unit, University of Auckland, Auckland, New Zealand.
Insights
Primary care documentation of cardiovascular risk factors is incomplete, hindering effective cardiovascular risk management. Systematic recording of key factors like smoking and diabetes is lacking, requiring significant investment for improvement.
Area of Science:
- Public Health
- Cardiovascular Medicine
- Health Informatics
Background:
- New Zealand guidelines emphasize absolute cardiovascular risk assessment.
- Accurate risk assessment relies on comprehensive patient data including age, sex, ethnicity, medical history, and lifestyle factors.
- Key risk factors include blood pressure, cholesterol levels, diabetes, and smoking status.
Purpose of the Study:
- To evaluate the completeness of cardiovascular risk factor documentation in primary care electronic health records.
- To identify the extent to which essential data for cardiovascular risk management is systematically recorded.
Main Methods:
- An audit of electronic patient records was conducted in Auckland primary care practices.
- The study included patients eligible for risk assessment, focusing on data documented before the implementation of a clinical decision support software.
- Audit nurses systematically searched for documented cardiovascular risk factors.
Main Results:
- The audit reviewed 1680 records from 84 general practitioners.
- Documentation rates varied: blood pressure (81.8%), cholesterol (62.4%), smoking status (41.5%), and diabetes (16.1%).
- Complete documentation of all assessed risk factors was only 6.8%; recording was higher for patients with existing cardiovascular disease or diabetes.
Conclusions:
- Primary care documentation of cardiovascular risk factors is significantly incomplete.
- Systematic recording of crucial factors like smoking and diabetes status is insufficient.
- Substantial investment and collaborative effort are needed to improve data collection for effective population-based cardiovascular risk management.
Background:
New Zealand guidelines recommend that cardiovascular risk management should be informed by the absolute risk of a cardiovascular event. This requires knowledge of a person's age, sex, ethnicity, medical and family history, blood pressure, total and HDL cholesterol, diabetes, and smoking status.
Aim:
To establish the extent of primary care documentation of cardiovascular risk factors.
Methods:
An audit of electronic patient records was conducted in practices affiliated with an Auckland primary care organisation (ProCare Health Ltd). The audited population were patients eligible for risk assessment (all Maori and a random sample of non-Maori) who had a consultation with their general practitioner during a four week study period (1 year before the doctor first used cardiovascular electronic clinical decision support software). Audit nurses searched for risk factors documented prior to the study period.
Results:
The records of 1680 individuals from 84 doctors were audited. The study periods prior to which the records were inspected ranged from August 2001 to June 2003. The proportions of records with risk factors documented were: blood pressure 81.8%, cholesterol 62.4%, smoking status 41.5%, diabetes status 16.1%, all these risk factors 6.8%. Recording of blood pressure and of cholesterol was higher in those with cardiovascular disease or diabetes. Recording of blood pressure increased with increasing age, then levelled off at about age 60 years. Documentation of cholesterol was lowest in the oldest and youngest age groups, and in women (at all ages) compared to men.
Conclusions:
Primary care documentation of cardiovascular risk factors was incomplete. Whilst many doctors may know whether patients are smokers or have diabetes, systematic documentation of these factors in particular, is not occurring. In order to realise the large potential benefits associated with population-based cardiovascular risk assessment and management, a substantial investment by government, healthcare organisations, health professionals, and patients is required to collect and record this information.
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