Assessment of cardiovascular risk in primary health care

The aim of this study was to determine the frequency of audit and the proportion completed in a group of practices. Data obtained by interviewing a member of each practice and inspecting practice records were independently coded by researchers. Practices initiated an average of 3.5 (range 1-7) audits in 2 years, of which an average of 0.9 (range 0-3) were completed. Ten of 16 completed audits were externally funded or facilitated. Few audits are com pleted in general practice and practices require continuing support for audit.     

Blood pressure and other cardiovascular risk factors among treated hypertensives in Swedish primary health care

OBJECTIVE: To evaluate antihypertensive treatment and other cardiovascular risk factors in primary health care. DESIGN: Cross-sectional survey of consecutive patients with treated hypertension in 1999. SETTING: 17 primary care centres in Sweden. SUBJECTS: 512 patients (mean age 67; SD 11 years). MAIN OUTCOME MEASURES: Antihypertensive treatment, cardiovascular risk factors. RESULTS: Patients with high diastolic BP (> or = 100 mmHg) and systolic BP (> 180 mmHg) values were few. The proportions with diastolic BP < 90, BP < 160/95 and < 140/90 mmHg were 64%, 54% and 15%. Mono-therapy was given in 51%, and > or = 3 drugs in 13%. Hypertensives with hyperlipidaemia were 42%, and only 26% of them were given lipid-lowering drugs, mainly statins, 21%. Smokers were 10%, 23% had diabetes, and many had overweight BMI = 25 kg/m2, 72%. CONCLUSION: Although two-thirds had diastolic BP < 90 mmHg, few had BP below the current treatment target < 140/90 mmHg. More than half of the hypertensives had at least one additional cardiovascular risk factor, and these hypertensives also had low proportions within several current treatment targets of hypertension and hyperlipidaemia, implying a need for intensified multiple risk factor intervention.     

Blood pressure and other cardiovascular risk factors among treated hypertensives in Swedish primary health care

Objective - To evaluate antihypertensive treatment and other cardiovascular risk factors in primary health care. Design - Cross-sectional survey of consecutive patients with treated hypertension in 1999. Setting - 17 primary care centres in Sweden. Subjects - 512 patients (mean age 67; SD 11 years). Main outcome measures - Antihypertensive treatment, cardiovascular risk factors. Results - Patients with high diastolic BP ( &#83 100 mmHg) and systolic BP ( > 180 mmHg) values were few. The proportions with diastolic BP < 90, BP < 160/95 and < 140/90 mmHg were 64%, 54% and 15%. Mono-therapy was given in 51%, and &#83 3 drugs in 13%. Hypertensives with hyperlipidaemia were 42%, and only 26% of them were given lipid-lowering drugs, mainly statins, 21%. Smok ers were 10%, 23% had diabetes, and many had overweight BMI = 25 kg/m2, 72%. Conclusion - Although two-thirds had diastolic BP < 90 mmHg, few had BP below the current treatment target < 140/90 mmHg. More than half of the hypertensives had at least one additional cardiovascular risk factor, and these hypertensives also had low proportions within several current treatment targets of hypertension and hyperlipidaemia, implying a need for intensified multiple risk factor intervention.     

Assessment of laboratory methods for detection of unsuspected diabetes in primary health care

In order to assess different methods for early detection of unsuspected diabetes, urine and venous blood samples were collected at random from 1082 patients visiting a primary health care centre in southern Sweden. Blood glucose was analysed by the hexokinase method along with the Dextrostix-Eyetone reflectance meter. Urine glucose was determined by Clinistix, Diastix, Neostix, Rediatest, Clinitest and quantitatively by the hexokinase method. Patients fulfilling the criteria of a positive screen were subjected to a diagnostic investigation with an oral glucose tolerance test. Out of 89 positive screenees, 37 patients were classified as diabetics, showing a prevalence of diabetes in the study population of 3.4% according to the WHO criteria. Impaired glucose tolerance was found in 14 patients. In a control group of 56 patients, randomly selected among negative screenees, no cases of diabetes were found. Random blood glucose measurement by the hexokinase method, using 7 mmol/l as a screening level, had a significantly higher sensitivity (95%) than all urine glucose methods (59-30%) with comparable specificity (97-99%). Use of the Dextrostix-Eyetone reflectance meter resulted in a decrease in sensitivity to 75% without any change in specificity or predictability, compared with the hexokinase method. Urine testing for glucose was found to be a suboptimal method for early case finding of diabetes among patients receiving primary health care.     

Prevention of cardiovascular disease within the primary health care system: Feasibility of a prevention programme within the Sollentuna primary health care catchment area

Objective - To integrate prevention of cardiovascular disease within the primary health care.

Design - A prevention programme which combines population and individual high-risk strategy.

Setting - The Primary Health Care in Sollentuna, Stockholm, Sweden.

Main outcome measure - Characteristics of, and risk factor prevalence among, persons registered in the prevention programme.

Results - During the first year more than 2000 persons, representing every tenth visitor and 6% of the population aged 15–60 years, were registered in the prevention programme. 90% were ?60 years and 62% were women. A large proportion (70%) had risk factors that required advice, treatment, and follow up. 24% of the men and 27% of the women were smokers, 68% and 62% respectively, had serum cholesterol ?5.2 mmol/1, and 33% and 22% had a diastolic blood pressure ?90 mmHg.

Conclusion - The present study implies that it is possible to integrate a large scale prevention programme in the existing primary health care organization. The prevalence of risk factors in those who enter the prevention programme is high, which places great demands for treatment and follow up.     

A centralized cardiovascular risk service to improve guideline adherence in private primary care offices

BackgroundMany large health systems now employ clinical pharmacists in team-based care to assist patients and physicians with management of cardiovascular (CV) diseases. However, small private offices often lack the resources to hire a clinical pharmacist for their office. The purpose of this study is to evaluate whether a centralized, web-based CV risk service (CVRS) managed by clinical pharmacists will improve guideline adherence in primary care medical offices in rural and small communities.MethodsThis study is a cluster randomized prospective trial in 12 primary care offices. Medical offices were randomized to either the CVRS intervention or usual care. The intervention will last for 12 months and all subjects will have research visits at baseline and 12 months. Primary outcomes will include adherence to treatment guidelines and control of key CV risk factors. Data will also be abstracted from the medical record at 30 months to determine if the intervention effect is sustained after it is discontinued.ConclusionsThis study will enroll subjects through 2015 and results will be available in 2018. This study will provide information on whether a distant, centralized CV risk service can improve guideline adherence in medical offices that lack the resources to employ clinical pharmacists.     

Proctosigmoidoscopy in primary health care

Of 282 patients who underwent rigid proctosigmoidoscopy (PSS) in primary care in the city of V?ster?s during 1985, 5.7% had polyps or tumours in the rectum. Barium examination of the large bowel was performed on 194 of these 282 patients and showed polyps or tumours in 6.2%. Use of these two methods led to diagnosis of polyps or tumour in the large bowel in 9.6% (27/282). Polyps were found by both methods in only one patient. Of four patients with tumours, two were discovered by barium examination and two by PSS. Barium examination and PSS complement each other in the search for polyps and tumours in the large bowel.     

Assessment of risk of falls in the elderly through a screening protocol in primary care

ObjectivesTo evaluate the extent to which the “frail elderly” protocol is applied in the population aged more than 79 years and the results for each of its subsections, and to evaluate the association between a history of falls in the subpopulation in which the protocol was applied and the protocol's screening variables.MethodA multicenter, observational, cross-sectional, cross association study was performed between July 2003 and December 2005 in 4 semi-urban health areas of Baix Empordá (Gerona, Spain) with a population of 81,548 inhabitants, of which 4.6% are > 79 years of age. The study population consisted of men and women aged > 79 years (target population for the computer protocol). Patients receiving home care were excluded. Data were extracted from the program's database.ResultsA total of 3,386 persons were studied, of whom the protocol was applied in 1,260 (37.2%). Thirty-six percent (449 elders) had a history of falls. A statistically significant relationship (p<0.005) was found between a history of falls and the following variables: the presence of physical barriers, having an incapacitating disorder, taking more than five drugs, taking psychiatric medications, alterations on the unipodal test, altered time up and go test or Whisper test, altered vision, need for assistance in basic activities daily living, leaving the home < 2 times per week, and absence of recreational activities.ConclusionsThe protocol is useful for the detection of elderly individuals at risk of falling, since most of the variables showed a statistically significant relationship with falls. Application of this protocol should be encouraged.     

Health risk appraisal in primary care

Preventive medicine focuses on the identification of factors that will lead to disability or disease and then the discovery of ways to eliminate or at least minimize these risk factors. In this article, the authors outline a guide for primary health care practitioners to practice preventive medicine using a computerized individual risk appraisal.     

Setting up a cardiovascular clinic in primary care

This article describes what nurses need to know about setting up a cardiovascular clinic in primary care. The author provides practical advice from personal experience of running such a clinic. Areas covered include: identifying patients; how to contact patients; what equipment to include; the consultation; follow up appointments and referrals.