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Journal of Public Health Advance Access originally published online on October 11, 2006
Journal of Public Health 2006 28(4):361-369; doi:10.1093/pubmed/fdl052
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© The Author 2006, Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved.

Audit-based education to reduce suboptimal management of cholesterol in primary care: a before and after study



S. de Lusignan, Senior Lecturer

J. Belsey, Honorary Research Assistant

N. Hague, Research Fellow

N. Dhoul, Research Assistant

J. van Vlymen, Research Assistant
Primary Care Informatics, Division of Community Health Sciences, St George’s – University of London, London SW17 ORE, UK

Address correspondence to S. de Lusignan, E-mail: slusigna{at}sgul.ac.uk

Background Statins are recommended for the secondary prevention of cardiovascular disease, although they are often used in suboptimal doses and some patients may not receive lipid-lowering therapy. The Primary Care Data Quality (PCDQ) programme is an audit-based educational intervention.

Objective To report the PCDQ programme’s effect on the cholesterol management in cardiovascular disease.

Subjects and methods Anonymized general practice data from 99 practices; 5% (n = 29 915) had cardiovascular diagnoses.

Results Mean cholesterol fell from 4.75 to 4.64 mmol l–1; patients achieving cholesterol target (< 5 mmol l–1) rose from 45.3 to 53.2%. Coronary heart disease patients achieved better control (mean 4.57 mmol l–1) than those with stroke (4.87 mmol l–1) or peripheral vascular disease (4.93 mmol l–1). Statin prescribing increased from 57.5 to 62.7%. Patients with diabetes [odds ratio (OR) 2.06, 95% confidence interval (95% CI) 1.91–2.21], prior myocardial infarction (MI) (OR 1.93, 95% CI 1.80–2.07), revascularization (OR 1.52, 95% CI 1.33–1.73) and smokers (OR 1.31, 95% CI 1.23–1.39) were more likely to receive statins, whereas people aged 75+ (OR 0.48, 95% CI 0.45–0.50), females (OR 0.90, 95% CI 0.86–0.94) and non-CHD-diagnosed (OR 0.36, 95% CI 0.34–0.38) were less likely.

Conclusions Diagnostic coding and number of patients who had their cholesterol measured and treated increased. There was no significant change in dosage used or inequity between the different groups prescribed statins.

Keywords: cardiovascular diseases, cholesterol, computerized statins, family practices, HMG-CoA, medical records system, myocardial ischemia


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