Audit of primary care angina management in Sandwell, England.
This audit aimed to assess the identification and treatment of coronary risk factors, lifestyle advice given and use of drug therapy, among patients with angina in Sandwell. It was designed to help general practices evaluate their angina management, and highlight areas where practice could be improved. Criteria were based on Sandwell's published angina audit and local clinical guidelines. Each participating practice was asked to identify all patients with angina, from which a 10% sample was randomly selected. The notes of each selected patient were examined for evidence showing whether agreed standards of care had been achieved. Fifteen practices took part, and contributed data on a total of 358 patients. Of patients without contraindications, 66.5% were taking aspirin, 62.1% were prescribed short-acting nitrates and 58.4% were prescribed beta-blockers. Non-white patients were significantly less likely to receive short-acting nitrates (p < 0.001) and women were significantly less likely to receive beta-blockers (p < 0.01). A total of 83.5% of patients had received smoking cessation advice, 75.1% had weight advice, 75.1% were advised about alcohol use and 64.5% about exercise. Overall, 77.4% had a blood pressure check within the previous twelve months, 40.5% had their cholesterol measured and 33.5% had their blood glucose measured. Non-white patients were significantly less likely to receive smoking cessation, weight, exercise and alcohol advice and were less likely to have their blood pressure checked (all p < 0.0001). Patients aged 65 and over were significantly less likely to receive a cholesterol check (p < 0.0001). None of the auditable standards were actually met. This study shows that there is considerable scope to improve the management of angina patients, with particular regard to aspirin. We recommend that practices develop systems to ensure that the appropriate treatment, advice and checks are given to all patients with angina, paying particular attention to those from ethnic minority backgrounds.
School of Health, University of Wolverhampton, 62-68 Lichfield Street, Wolverhampton WV1 1SB, England. tony.stewart@wlv.ac.uk
A
A
Stewart
J
J
Rao
G
G
Osho-Williams
M
M
Fairfield
R
R
Ahmad
D000787:Angina Pectoris / Q000175:diagnosis / Q000188:drug therapy*; D001786:Blood Glucose / Q000032:analysis; D001795:Blood Pressure Determination; D002317:Cardiovascular Agents / Q000627:therapeutic use; D002784:Cholesterol / Q000032:analysis; D003376:Counseling / Q000706:statistics & numerical data; D011307:Drug Prescriptions; D004363:Drug Utilization / Q000706:statistics & numerical data; D004739:England; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D008019:Life Style; D008297:Male; D008485:Medical Audit; D010346:Patient Care Management / Q000592:standards; D010353:Patient Education as Topic; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000458:organization & administration / Q000592:standards*
D001786:Blood Glucose; D002317:Cardiovascular Agents; D002784:Cholesterol